Costs of Illegal Immigrant Healthcare at Center of New Executive Order

Estimated Time to Read: 6 minutes

On August 8, 2024, Texas Governor Greg Abbott (R) issued an Executive Order (EO) mandating that Texas hospitals document and report the costs of providing healthcare to illegal immigrants. The order requires that, starting November 1, hospitals and other healthcare providers must collect this data and report it quarterly to the Texas Health and Human Services Commission (HHSC), with the first submissions due by March 1, 2025. Following the initial report, hospitals will continue to provide annual updates starting January 1, 2026, to the Governor, the Lieutenant Governor, and the Speaker of the House.

In his announcement, Abbott stated, “Texans should not have to foot the bill for illegal immigrants’ healthcare.” The EO aims to quantify the financial strain on Texas’ healthcare system, which Abbott attributes to what he describes as the “Biden-Harris Administration’s reckless open border policies.”

The Financial Impact on Texas Hospitals

In March 2021, Texas Attorney General Ken Paxton (R) revealed that illegal immigration costs Texas taxpayers over $850 million each year. Specifically, concerning healthcare, Paxton asserted that “Texans pay between $579 million and $717 million each year for public hospital districts to provide uncompensated care for illegal aliens.”

The financial toll on Texas hospitals, particularly those in rural areas, has been exacerbated by the increased number of illegal immigrants seeking care. Rural hospitals, heavily reliant on government funding, are especially vulnerable. Abbott’s EO seeks to provide a clear picture of the economic burden on these institutions, potentially paving the way for the state to seek reimbursement from the federal government.

Abbott has argued that the Biden administration’s policies have forced Texas to cover costs that should be the federal government’s responsibility. By mandating the collection of this data, Abbott aims to build a case against the federal government, holding it accountable for the financial implications of its border policies.

The EO references the “more than 11 million people…entering this country illegally in less than four years under the Biden-Harris Administration,” further emphasizing the perceived scale of the issue. Abbott has consistently criticized the federal government’s handling of border security, arguing that Texas has been left to bear the consequences of these policies.

Legal and Constitutional Context

Abbott’s EO also touches on the broader legal and constitutional context surrounding state and federal responsibilities. In January, Abbott asserted that Texas has a “constitutional right to defend and protect itself” in light of the surge in illegal immigration. This claim has been echoed by several Texas counties, many of which have declared an “invasion” on the southern border.

This rhetoric was recently reinforced by the U.S. Court of Appeals for the 5th Circuit, which allowed Texas to maintain its buoy barrier in the Rio Grande. Judge James Ho supported Abbott’s argument, stating that “a sovereign isn’t a sovereign if it can’t defend itself against invasion… States did not forfeit this sovereign prerogative when they joined the Union.” This legal backing strengthens Abbott’s position that Texas has the right, and indeed the obligation, to protect itself from the consequences of federal border policies.

The Role of Public Opinion and Political Strategy

Abbott’s EO and the accompanying rhetoric are almost certainly part of a broader political strategy aimed at galvanizing support among Texans who are frustrated with the federal government’s handling of border security. By framing the issue as one of state sovereignty and fiscal responsibility, Abbott is positioning himself and his administration as defenders of Texan interests against what they perceive as an absence of federal action.

Public opinion in Texas has been increasingly supportive of stronger border measures, especially as the effects of illegal immigration are felt more acutely in local communities. The EO can be seen as a response to these concerns, with Abbott aiming to demonstrate that his administration is taking tangible steps to address the issue.

The Road Ahead

While Abbott’s EO could be a significant step in addressing the financial burden of illegal immigration on Texas hospitals, it is also likely to face challenges. The EO could set the stage for further legal battles between the state and federal government, particularly if Texas seeks reimbursement for the reported costs. In the coming months, the impact of Abbott’s EO will become clearer as hospitals begin to collect and report the required data. This information will not only provide a more detailed understanding of the costs associated with illegal immigration but could also catalyze broader discussions on the relationship between state and federal responsibilities in managing immigration and healthcare.

The 89th Legislative Session is set to begin in January 2025. Almost certainly, the topic of border security will continue to be one addressed by state lawmakers.

Texas Lawmaker Reactions

Conclusion

Governor Greg Abbott’s executive order to collect and report healthcare costs for illegal immigrants marks a significant development in the ongoing debate over immigration and state sovereignty. By mandating the collection of this data, Abbott aims to highlight the financial impact of federal border policies on Texas and to hold the Biden administration accountable for what he views as its failure to secure the border.

As Texas hospitals begin to implement these reporting requirements, the state will gain a clearer picture of the financial burden it has shouldered due to illegal immigration. Whether this will lead to a reimbursement from the federal government or further legal and political battles remains to be seen.

Texas Policy Research relies on the support of generous donors across Texas.
If you found this information helpful, please consider supporting our efforts! Thank you!