Undocumented immigrants visited Tarrant County emergency rooms 5,545 times from November through February, according to a body of data gathered by the state.
Visits to emergency rooms and inpatient care totaled over $28 million. Hospitals were instructed not to report payments received for that care, such as from insurance or out of pocket.
Gov. Greg Abbott issued an executive order a year ago requiring hospitals to report health care costs for treating undocumented patients. Abbott wrote in his order that providing health care to undocumented immigrants burdens the health care system and drives up costs.
“Texans ultimately bear the costs associated with public financial support for medical care for individuals who are not lawfully present in the United States, in the form of higher taxes,” Abbott’s order read.
Overall, undocumented immigrants are the minority of uninsured patients in Texas, a nonpartisan policy and advocacy group said.
Texas hospitals began collecting data on the number of patients they see per immigration status and cost of care on Nov. 1 with their first submission to the state due by March 1. Hospital staff must inform patients that, under federal law, responding to questions about their immigration status would not impact their health care.
Through a public records request, the Fort Worth Report obtained the state data submitted by Texas hospitals. Here are the takeaways:
Tarrant County’s public hospital saw the most undocumented patients
Among the county’s 34 responding hospitals, nearly 45% of emergency room visits by undocumented patients were reported by John Peter Smith Hospital — 2,447 over the four-month reporting period.
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Excluding accidents, acute illness and mental health care, undocumented immigrants visiting the emergency room typically fall into two main groups: primary care for problems stemming from untreated chronic conditions and recurring care for ongoing issues that are fixable, said Kathryn Keaton, director of Project Access Tarrant County, an initiative that helps low-income, uninsured Tarrant County residents access medical procedures.
Many may visit an emergency room for primary care because they are not aware of clinics that offer services or cannot go during clinic business hours, Keaton said.
For those with ongoing but fixable health problems, the patients receive treatment at the emergency room that temporarily improves their condition — such as pain medication or a blood transfusion — but soon return for the same issue, she said.
“We call it the ER roulette,” Keaton said. “It’s the reality.”
Project Access connects those it serves — 95% of whom Keaton estimates are undocumented — with doctors and hospitals willing to donate time, services and other resources for one-time fix procedures such as gallbladder removals and hysterectomies.
Clinics such as Cornerstone Assistance Network, Mercy Clinic, GRACE Grapevine, Mission Arlington and North Texas Area Community Health Centers provide primary care in Tarrant County.
25 Tarrant County hospitals reported $28 million in care costs
While local hospital care costs for undocumented patients during the four-month period reached $28.3 million, that figure does not reflect any payments made by patients, insurance companies or Medicaid.
The JPS Health Network accounted for the bulk of costs, reporting more than $15 million in services provided.
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Because hospitals cannot include revenue offsets in reports to the state, numbers reported on the form reflect the gross cost of treating patients and do not take into account any payment received, said Daniel Karnuta, director of the Professional Program in Healthcare Management at the University of Texas at Dallas.
Undocumented immigrants are eligible for Medicaid in emergency circumstances only if they meet all other requirements, such as income and age.
Keaton said Project Access does not track the percentage of those it serves who file federal income taxes but said it is at least 50%.
The nonprofit American Immigration Council estimated that 124,500 undocumented immigrants were living in Tarrant County in 2019 and that they paid $147.8 million in federal taxes and $105.5 million in state and local taxes.
Tarrant County sees fourth-highest number of emergency visits by undocumented immigrants in Texas
Across Texas, undocumented immigrants accounted for nearly 85,000 visits to emergency rooms. Tarrant County had the fourth-highest number of visits in the state, behind Dallas, Harris and Travis counties.
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In 2022, Texas had the second-highest number of undocumented immigrants in the United States at 1.6 million, according to the Pew Research Center.
In his executive order, Abbott highlighted a “surge” of illegal border crossings in recent years and said hospitals’ increased costs for undocumented immigrants’ health care “imposes burdens on the Texas healthcare system, including by predictably increasing the costs of medical care for all Texans.”
According to 2023 data from the U.S. Census Bureau, 16.4% of Texas residents are uninsured, more than any other state. Nationally, 7.9% of Americans are uninsured.
Undocumented immigrants make up the minority of the uninsured population in the state, said Charles Miller, Texas 2036’s director of health and economic mobility policy, to The Texas Tribune. The nonpartisan policy and advocacy group estimates undocumented immigrants are 14% of the state’s uninsured population.
The number of uninsured Texans is expected to grow by roughly 480,000 people, or one percentage point, by 2034 due to Medicaid and Affordable Care Act Marketplace changes in the One Big Beautiful Bill Act, according to the nonprofit health policy organization KFF.
McKinnon Rice is the higher education reporter for the Fort Worth Report. Contact her at mckinnon.rice@fortworthreport.org.
At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here.
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