Audio recording is automated for accessibility. Humans wrote and edited the story. See our AI policy, and give us feedback.
Sign up for The Brief, The Texas Tribune’s daily newsletter that keeps readers up to speed on the most essential Texas news.
Texas hospitals received nearly 80,000 visits from undocumented patients from December through February at a cost of $329 million, according to data released by the Texas Health and Human Services Commission on Wednesday. That’s about 2% of all patient visits during that three-month period.
The state released its second round of data intended to show how much Texas hospitals spend on care for undocumented immigrants but excludes critical context, such as how much of that cost is actually paid by undocumented patients or how it compares to total unpaid hospital care costs, according to advocates.
While the state characterizes the figure as costs from Dec. 1, 2024 through Feb. 28, 2025, the data does not reflect any payments made by patients to cover those treatment costs according to an HHSC spokesperson, who said the agency does not have that data. Earlier this year, HHSC reported that 30,000 undocumented patients received about $118 million worth of care.
“We knew it wouldn’t give us good data,” said Lynn Cowles, health and food justice programs manager at left-leaning think tank Every Texan, which advocates for better health care. The aim of the governor’s executive order is “reflective of the governor’s true intention which is to make this an unfriendly place for immigrants.”
Last year, Gov. Greg Abbott ordered Texas hospitals to ask patients if they were “legally present” in the United States, because he believes the costs to Texas hospitals for that care “imposes burdens on the Texas healthcare system, including by predictably increasing the costs of medical care for all Texans.”
His order also states “the federal government may and should be obligated to reimburse” Texas for the costs associated with its “open-border policies.”
This data is an estimate because it only tabulates costs by patients who voluntarily participated in the Abbott-mandated survey. It also fails to include any payments made by patients toward those costs.
Also, not included in the data release is how much uninsured, lawfully present Texas residents cost hospitals. Policy analysts have told The Texas Tribune they believed that cost to be far larger since the state has among the nation’s highest uninsured rate. Wednesday’s data shows 3.1 million lawfully-present patients visited Texas hospitals during the three months, but it doesn’t show how many of them are uninsured.
🎇 Independence Day Sale 🎇
$30 off TribFest tickets!Act fast: Offer ends
midnight July 4.
TribFest 2025 is presented by JPMorganChase
The Texas Tribune sent a request to Abbott’s press office to elaborate on what he wants to do with this information and that request was not immediately answered.
Advocacy groups have emphasized that patients are not required to answer the citizenship question and hospital officials have said patients will not risk having their treatment interrupted if they say they are not legally present in the U.S. In April, hospitals reported they incurred $121.8 million in health care costs before any payment was made during November 2024. That number has since been adjusted by the state to $118 million.
Data has shown for years that undocumented immigrants who lack access to health insurance plans, Medicaid included, typically use hospitals less than American citizens who are uninsured – Texas hospitals spend $3.1 billion a year on uninsured care that is not reimbursed, according to the Texas Hospital Association. Even emergency Medicaid spending, which by design, covers undocumented immigrants’ hospital costs in limited circumstances, has gone down in the last five years.
Patients not lawfully in the United States could either pay for their care out of pocket, or through private insurance plans they have purchased. They are not eligible to participate in Medicare, CHIP or Affordable Care Act insurance plans and many are working in jobs without employer health benefits. Emergency Medicaid coverage can be applied by a hospital to cover a patient’s bill.
Texas has the highest uninsured rate in the country, according to recent estimates from the U.S. Census Bureau. About 4.8 million or 19% of Texas children and adults under the age of 65 lacked health insurance in 2023. The state has 1.7 million undocumented immigrants.
Charles Miller, a former Abbott policy and budget advisor who is now with the policy organization Texas 2036, said his group’s best estimate shows about 15%, or about 730,000, of Texas’ uninsured are non-citizens that were not lawful permanent residents.
“We do have a fairly sizable population of undocumented uninsured, but it is not the majority,” Miller, director of health and economic stability policy at Texas 2036, said last fall. “So if we’re talking about who is the majority of the uninsured, that is going to be folks who are here legally.”
Disclosure: Every Texan, Texas 2036, and Texas Hospital Association have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. Find a complete list of them here.
🎆 During our Independence Day Sale, save $30 on your TribFest ticket.* Tribune members, students and educators save even more! Act fast — Offer ends at midnight Friday, July 4.
*Discount does not apply to Executive or VIP tickets
TribFest 2025 is presented by JPMorganChase.