Impact, potential fallout of Abbott executive order for public hospitals treating undocumented migrants

Community leaders and advocates are expressing concerns over an executive order issued Thursday by Texas Governor Greg Abbott.

If it survives anticipated legal challenges, the order directs all public hospitals in Texas to begin collecting and issuing reports related to undocumented patients in their care.

The governor blames the Biden Administration and an increase in illegal crossings over the past four years for the action taken, although illegal crossings are currently down from record highs.

Community advocates are urging worried migrants to continue seeking necessary medical care without fear of deportation.

Gov. Abbott’s order states ‘the state of Texas absorbs a large percentage of the costs associated with medical care for individuals who are not lawfully present in the United States’ and ‘Texans ultimately bear the costs associated in the form of higher taxes.’

Texas healthcare providers are now quickly reviewing Executive Order No. GA-46 which states ‘increased expenditures for Texas hospitals providing medical care to individuals who are not lawfully present in the United States imposes burdens on the Texas healthcare system, including by predictably increasing the costs of medical care for all Texans.’

Dallas community clinic Guadalupe Medical, which is not impacted by the executive order, shared insight on what impact the order could have on migrants.

"The fear from people who don’t have documentation will be if they go to the hospital they’ll be notified or persecuted for going to the hospital because they don’t have papers,” Dr. Marcial Oquendo, a physician at Guadalupe Medical Clinic. “However, the intention of this is to be able to record the cost associated with having to take care of people who don’t have papers because the money has to come from somewhere, usually it comes from taxpayers.”

Oquendo urges anyone experiencing a medical emergency to still seek out a hospital, regardless of immigration status.

Hospitals currently do not ask about patient status as a condition of treatment and federal law requires life-saving treatment to anyone, regardless of their immigration status.

Gov. Abbott’s executive order directs Texas public hospitals to start collecting the number of inpatient discharges and emergency room visits involving undocumented people, as well as the cost of care provided to them, beginning November 1.

Impacted hospitals are also directed to inform patients that collected information will not affect patient care.

Abbott is asking hospital leadership to provide the Texas Department of Health and Human Services with a quarterly report, and an annual report to the governor, lieutenant governor, and speaker of the Texas House, by March 2025.

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

The governor’s move is being met with blistering criticism, including from Rene Martinez, president of LULAC-100.

“It's very, very hypocritical where the governor is spending billions, not millions, billions of dollars in terms of doing things on the border,” said Martinez.

The longtime Dallas civil rights leader points to the recent Cato Institute’s investigation into the fiscal impact of immigration in the U.S. in 1997 and 2017, finding ‘With some variation and exceptions, the net fiscal impact of immigrants is more positive than it is for native‐​born Americans and positive overall for the federal and state/​local governments.’

“Data that I've seen before that undocumented people get on a pay plan, they begin to pay what they owe at Parkland,” said Martinez. “They don't pay all at one time, they pay over a period of time, but they pay their bills, compared to U.S. citizens who have a worse history of paying their debt.”

Martinez and Dallas County Commissioner Elba Garcia say the order is simply a hate-filled political tactic meant to divide and create fear in an election year.

“Imagine a community without health without education without services,” said Garcia. “What are you going to have, women without prenatal care? What are you going to have students getting sick and not going to school? What are you going to have our elderly without any kind of care?”

According to Garcia, Parkland Hospital, the county’s public hospital, does not currently provide commissioners with a breakdown of such costs, ‘because it is HIPAA-protected information.’

Garcia’s advice: “Don’t be scared. This is going to be in court and more importantly, we are, in Dallas County, we care about our people we care about the health of our community.”

A spokesperson for Parkland directed NBC 5 to HHS and the governor’s office with any questions.

The Texas Hospital Association in Austin tells NBC 5:

“This would be a new requirement, and we are reviewing it as quickly as possible. Right now, hospitals don’t ask about patient immigration status as a condition of treatment. Hospitals are required by law to provide life-saving treatment to anyone, regardless of ability to pay or status.”

 When reached for comment, Dallas-Fort Worth Hospital Council CEO Stephen Love provided NBC 5 the following statement:

“Our hospitals comply with EMTALA and treat patients that need medical care, especially in our emergency departments. This is the compassionate and caring treatment we strive to render to all patients.  Regarding the executive order and how the state wants to collect data, hospitals always comply with federal, state and local regulations and requirements. We will obviously work with the state agencies to comply with new procedures, regulations or requirements.”

Martinez says he is sure the numbers will prove migrants do not create a burden on taxpayers.

“Abbott is creating fear,” he said. “Abbott is creating an atmosphere of hate for people by doing this.”

Dr. Oquendo predicts several scenarios could play out.

“People might think twice about going to the hospital for maybe a cold or diarrhea and vomiting,” he said. “The cost of dealing with a cold or a virus or a belly pain at a primary care center, the cost is very low versus going to the hospital where the cost is very, very high.”

Oquendo says in reality, the ‘vast majority’ of hospital visits could be taken care of at a community clinic or urgent care.

He warns, that while the order could cut down on unnecessary trips to the hospital, those who do need help might avoid seeking necessary care out of fear, only to end up with severe complications requiring hospitalization costing taxpayers even more money down the line.

“They might get sicker before they actually end up at the hospital,” said Oquendo.

The physician urges anyone in need, regardless of status, to immediately seek out a community clinic or primary care doctor for preventive care to not only avoid hospital visits for minor health problems but to stop or slow medical illnesses before they worsen and require costly hospitalizations.

“Clinics across the metroplex, clinics that are designed for these populations, are still going to be working. If anything, they’re going to have to be working harder,” said Oquendo. “It’s definitely going to be different paying for healthcare in one of these clinics than paying for healthcare in one of these hospitals which is going to be 10 times, 20 times the cost.”