Gov. Greg Abbott orders hospitals to report treatment costs for undocumented migrants

AUSTIN — Gov. Greg Abbott on Thursday ordered the state’s health agency to monitor and report the cost of treating undocumented migrants in state public hospitals.
Abbott, who has taken a leading role in criticizing Democratic border policies in a presidential election year, said the state will seek reimbursement from the federal government for costs associated with the “reckless open border policies” of President Joe Biden and Vice President Kamala Harris.
“Texans should not have to shoulder the burden of financially supporting medical care for illegal immigrants,” Abbott said in a statement accompanying his executive order.
Abbott directed the Texas Health and Human Services Commission to require state hospitals to document, and report quarterly, the costs of treating “patients who are not lawfully present in the United States.”
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The state agency will begin providing an annual report of costs to the governor, lieutenant governor and speaker of the Texas House beginning in January 2026.
Hospital employees must inform patients that if they are undocumented, it will not affect their ability to receive care, according to the executive order.
Texans should NOT have to foot the bill for illegal immigrants healthcare.I issued an Executive Order directing HHSC to collect & report healthcare costs for illegal immigrants.We’ll fight to ensure the Biden-Harris Admin pays back Texas for their costly open border policies. pic.twitter.com/NRHzXiJ1VH
Luis Figueroa, the chief of legislative affairs for Every Texan, a left-leaning public policy nonprofit, said in a brief phone interview that he feared the executive order could lead migrants to avoid care over fears they will be reported to federal immigration authorities.
“People are going to be hesitant to go to emergency rooms, which only makes our communities less safe when it comes to receiving the care that they need,” Figueroa said.
Kassandra Gonzalez, a staff attorney for the Beyond Borders Program with the Texas Civil Rights Project, said in an email that the executive order is “xenophobic smoke and mirrors” because “there is no evidence that Texas loses money because of undocumented immigrants’ healthcare costs.”
Gonzalez pointed to a 2023 study by the CATO Institute, a libertarian think tank, that found on average immigrants pay more in taxes than they consume in benefits.
“Thus, Abbott’s cruel policy is targeting the very people who provide state services — services that we all depend on and use,” Gonzalez said.
A spokesperson with the Texas Hospital Association said in an emailed statement that Abbott’s order is a new requirement and hospitals currently don’t ask a patient their immigration status as a condition of treatment.
“Hospitals are required by law to provide life-saving treatment to anyone, regardless of ability to pay or status,” the statement said.
The executive order is the latest action Abbott has taken on immigration, a topic that has played a central role in a presidential election pitting Democrat Harris against Republican Donald Trump..
Abbott has bused tens of thousands of migrants to Democratic-run cities across the country and instituted Operation Lone Star, a multibillion-dollar border security initiative using Texas Department of Public Safety troopers and National Guard soldiers to arrest undocumented migrants for trespassing on private property along the U.S.-Mexico border.
He also ordered soldiers to deploy razor wire along miles of the border with Mexico and directed a line of buoys to be placed in the Rio Grande near Eagle Pass to deter migrants from crossing that section of the river.