Health Care Costs and Hospital Finance

Newly compiled data from the Texas Health and Human Services Commission show that Texas hospitals reported $1.05 billion in costs during fiscal year 2025 tied to patients classified as "individuals not lawfully present" in the United States, based on 313,742 recorded visits. The figures, the first collected under an August 2024 executive order by Gov. Greg Abbott, cover reporting that began in November 2024 and average roughly $105 million per month, suggesting the true 12‑month total could be higher than what is captured. The largest share of expenses — about $565.4 million — came from inpatient discharges for non‑Medicaid and non‑CHIP patients, while emergency department visits for that same group added roughly $205.5 million; Medicaid and CHIP enrollees accounted for another $279.6 million in inpatient and emergency costs combined. Abbott’s order requires hospitals to file quarterly breakdowns of inpatient discharges, ER visits and associated costs for patients not lawfully present, a move his office frames as necessary amid record border crossings and pressure on state services. Supporters are already using the numbers to argue that unauthorized immigration is straining public resources, while critics are likely to question the methodology, how immigration status is determined in clinical settings, and whether these costs are being double‑counted or offset by taxes and economic activity.