Early Texas hospital data shows millions spent in care for non-U.S. citizens

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Preliminary data shows that “tens of thousands” of patients who were not “lawfully” in the United States were treated by Texas hospitals in recent months and the cost for their care is in the millions of dollars, according to a state employee testifying before lawmakers late Monday.

Gov. Greg Abbott ordered Texas hospitals last summer to begin asking all patients to disclose whether they were “lawfully in the United States.” Patients were told their answers would not jeopardize their access to health care but they were not legally required to answer.

Hospitals were expected to turn in their first months of data by March 1 but it has not been released publicly yet.

But during a House Public Health Committee hearing on a bill from state Rep. Mike Olcott, R-Fort Worth, that would formalize Abbott’s order into a regular annual report each year, a Texas Health and Human Services Commission executive answered lawmakers’ questions about what the agency has learned so far from the 558 Texas hospitals that have responded to Abbott’s order.

“The number of visits was in the thousands, the tens of thousands, and the costs were in the millions,” said Victoria Grady, director of provider finance at HHSC. “We should be finalizing the data by the end of the week.”

Several media outlets, including The Texas Tribune, have asked for the data following the hospitals’ first March 1 deadline set by Abbott’s office. Grady and Olcott detailed why there’s been such a delay in getting that first snapshot out into the public view.

“They actually got some data on like pieces of paper,” Olcott told committee members. Grady confirmed that the agency has had to, on occasion, manually input data on paper that was mailed into the agency from some hospitals into a spreadsheet. She also said she expects the data to be released by the agency later this week.

Abbott’s order told hospitals to begin collecting information in November 2024. But it’s not clear if the data collected by the 558 hospitals was just for that month or all months since then.

Olcott said his bill, like one already passed in 2023 in Florida, is necessary because it would streamline the survey process and keep Texans informed about how their tax dollars were spent.

“Since 2005, we’ve had 181 small rural hospitals close primarily due to uncompensated care,” Olcott said. “The goal of this is simply to know what percentage of that uncompensated care are due to people here illegally.”

According to the Texas Hospital Association, hospitals in this state spend $3.1 billion a year on uninsured care that is not reimbursed. But a large portion of that is for American citizens who are uninsured in Texas. The state has one of the highest rates of uninsured residents in the nation, with more than 4 million without health insurance coverage.

Lynn Cowles, health and food justice programs manager at Every Texan, which advocates for better health care in Texas, testified on that fact.

“I think one of the big issues with this bill –– if it is intended to understand the problems of rural hospitals closing across the state –– is that the pool of uncompensated care is so large because of the amount of citizens who are uninsured in Texas,” Cowles said.

Disclosure: Every Texan 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.

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