New challenge for undocumented immigrants

Experts discuss Abbott’s executive order’s impact on Texas health care system

Gov. Greg Abbott’s Aug. 8 executive order mandates Texas hospitals to collect and report health care costs of illegal immigrants, leading to concerns that hospitals are becoming “a third arm of the immigration system,” according to a Harlingen immigration attorney.

Abbott signed the order that requires Texas public hospitals to collect information on “patients who are not lawfully present in the United States, including the number of inpatient discharges and emergency visits by and the cost of the care provided to such patients,” starting Nov. 1.

Under the order, people cannot refuse to give their status. 

The Emergency Medical Treatment & Labor Act requires Medicare-funded hospitals to provide essential care to patients experiencing health-related emergencies regardless of their ability to pay or status.

Attorney Aimeé A. Treviño said Abbott’s executive order conflicts with federal law, so lawsuits may arise to assess its legality.

“It’s unconstitutional,” Treviño said. “The Supreme Court has said, you know, you have to provide care to those regardless of their status. So, now that we have a database or, you know, they’re hoping to have a database, people are not going to seek health care. They’re going to be afraid that they’re going to go to the doctor for, you know, a serious emergency and they’re going to get arrested.” 

Hospitals are required to submit the information to the Health and Services Commission on a quarterly basis, with the first submission due by March 1, 2025.

Starting Jan. 1, 2026, hospitals will report annually to the governor, the lieutenant governor and the speaker of the Texas House regarding the costs of inpatient and emergency care for the previous state fiscal year for patients who are not lawfully residing in the country.

“[Health care providers] are going to be expected to ask, ‘What’s your status? Can I see your papers?’” Treviño said. “And they’re going to have to decide whether they believe that those papers are valid, whether they’re fraudulent and basically decide someone’s immigration status in a hospital.”

She said health care providers should not be the judge to determine the authenticity of the document provided by a patient.

“That’s not your role,” Treviño said. “Just provide your medical service as you’re supposed to, as a doctor should, as a nurse should, and continue helping people. Because that’s why they’re in the medical profession, to help other people.”

The executive order reads that the federal government must reimburse the state for the costs “that its open-border policies have imposed on Texans, costs of which the State had no notice and which it could not have anticipated when agreeing to shared health-funding mechanisms on the premise that the federal government would follow federal laws.” 

Alvaro Corral, an assistant professor in the UTRGV Department of Political Science, said people will be scared to seek medical care with the executive order.

“Former President Trump’s current campaign has been very clear about stating that they intend to create, in their words, the largest deportation of undocumented people this country has seen,” Corral said, referencing Trump’s campaign platform, which can be found on donaldjtrump.com. “And so, if we have this data and then this data is being collected, you can imagine how people reasonably come to the conclusion that they should be fearful, right? 

“That if you seek medical care in Texas after Nov. 1 and under a potential Trump administration, people are, of course, putting those two things together and are obviously coming to the conclusion that they will likely be scared.”

The term “hospitals” includes acute care hospitals enrolled in Medicaid, the Children’s Health Insurance Program and any additional providers identified by the Health and Human Services Commission, according to the order.

The Rider contacted UT Health officials for an interview regarding how the order would be implemented. 

Saira Cabrera, communications manager for the UTRGV School of Medicine, wrote in an email on Aug. 14 that the executive order “does not impact UT Health RGV because we do not operate as a hospital.”