The Billion-Dollar Burden: Texas Hospitals Face Mounting Costs for Undocumented Immigrant Care
In a startling revelation that has significant implications for both healthcare policy and immigration debates, Texas hospitals incurred over $1 billion in healthcare costs associated with undocumented immigrants during fiscal year 2025. This eye-opening figure emerges from a new tracking initiative mandated by Governor Greg Abbott’s executive order signed in August 2024, requiring hospitals throughout the state to document and report the medical services provided to individuals not legally present in the United States. The Texas Health and Human Services Commission (HHSC) compiled this data, revealing that hospitals recorded 313,742 visits from undocumented individuals within the tracking period. What makes these numbers particularly concerning is that they represent approximately 1% of the state’s tax-funded resources—a significant portion of public money being directed toward emergency and inpatient care for non-citizens.
The tracking system, which only began in November 2024, means the actual annual costs are likely even higher than reported. With monthly expenditures averaging approximately $105 million, the complete yearly total would exceed the reported $1.05 billion if data from September and October had been included. Governor Abbott’s executive order specifically directed Texas hospitals to provide quarterly breakdowns of patients not lawfully present in the United States, including detailed information on inpatient discharges, emergency department visits, and the associated costs of care. This initiative represents one of the first systematic attempts to quantify the financial impact of providing healthcare to undocumented immigrants at the state level, particularly in a border state like Texas that has experienced record-high border crossings under the Biden administration.
The financial breakdown reveals that the largest portion of expenses—$565.4 million—came from inpatient discharges for patients not enrolled in Medicaid or the Children’s Health Insurance Program (CHIP), spanning 40,947 individual discharges. Emergency department visits for similar non-Medicaid and non-CHIP patients added another substantial sum of $205.5 million to the total. These figures highlight not just the volume of care being provided but also the high cost of delivering these medical services without the support of federal healthcare programs. The data paints a complex picture of how immigration patterns directly impact local healthcare systems, particularly in a state that shares a significant border with Mexico and serves as a primary entry point for many migrants seeking to enter the United States.
Even more revealing is that undocumented immigrants who were enrolled in Medicaid or CHIP programs generated significant additional costs, including $255.3 million for inpatient discharges and $24.3 million for emergency department visits. These figures raise important questions about eligibility criteria for public health insurance programs and how they intersect with immigration status. The quarterly reporting shows a relatively consistent pattern of high costs throughout the fiscal year. From December 2024 through February 2025, hospitals reported nearly 150,000 visits totaling $330.8 million. The spring months of March through May 2025 saw costs reach $319.3 million, followed by summer months (June through August) with expenses of $298.3 million. The initial November 2024 reporting period alone registered over 30,000 visits with costs exceeding $102 million.
The impact of these healthcare costs extends beyond simple budgetary concerns, touching on broader debates about immigration policy, public health responsibilities, and the ethical obligations of medical providers. Texas, as a border state, has been vocal about the challenges it faces due to federal immigration policies. Andrew Mahaleris, Governor Abbott’s press secretary, has emphasized that record-high border crossings under the current administration have placed “immense pressure” on the state’s healthcare system. This billion-dollar healthcare expenditure provides concrete evidence for those arguing that border states bear a disproportionate financial burden from immigration policies set at the federal level, while receiving inadequate federal support to address these costs.
As the nation continues to grapple with both healthcare reform and immigration policy, Texas’s data offers a sobering case study in the real-world intersection of these two challenging issues. The findings raise fundamental questions about who should bear the costs of providing healthcare to undocumented immigrants—state taxpayers, the federal government, or some combination of funding sources. They also highlight the practical realities faced by healthcare providers who are ethically bound to treat patients regardless of legal status, yet must operate within financial constraints. With healthcare costs approaching 1% of the state’s tax-funded resources, the economic implications cannot be ignored, especially as other states with significant immigrant populations may face similar challenges. This landmark tracking effort in Texas may well inspire other states to implement similar reporting requirements, potentially transforming the national conversation about immigration, healthcare access, and fiscal responsibility in profound ways.
