Preliminary data collected from hospitals across Texas reveals that tens of thousands of undocumented patients received medical treatment in recent months, costing the state’s health care system millions of dollars, according to testimony from a state health official this week. During a House Public Health Committee hearing on Monday, lawmakers reviewed a new bill introduced by Rep. Mike Olcott (R–Fort Worth) that would formalize Governor Greg Abbott’s 2024 executive order requiring hospitals to ask patients whether they are lawfully present in the United States. The aim of the bill is to create a structured, annual report of uncompensated care provided to undocumented individuals — a practice already enacted in states like Florida.

Though the data from 558 reporting hospitals has not yet been released publicly, Victoria Grady, director of provider finance at the Texas Health and Human Services Commission (HHSC), told lawmakers that the number of patient visits was in the “tens of thousands,” and the cost of care was in the “millions.” The hospitals were directed to begin collecting this information starting November 2024, with their first set of reports due March 1, 2025. However, due to various submission formats — including paper reports mailed in by some hospitals — the HHSC has encountered processing delays. Grady stated that the data is currently being compiled and is expected to be finalized by the end of the week.

Gov. Abbott’s directive specifies that patients are not legally required to answer the immigration status question and their response, or lack thereof, will not affect access to care. However, the move has sparked debate across the political spectrum, with supporters citing fiscal accountability and critics pointing to the larger systemic issue of uninsured care — especially among American citizens. Rep. Olcott defended the bill, stating that the intent is not to deter care but to understand how much of the state's financial burden comes from treating undocumented individuals, particularly in light of the 181 rural hospital closures since 2005. “The goal of this is simply to know what percentage of that uncompensated care is due to people here illegally,” he said.

But public health advocates cautioned lawmakers not to overlook the broader context. Lynn Cowles, a representative from Every Texan, a health equity advocacy group, testified that a large portion of the $3.1 billion in uncompensated care provided by Texas hospitals each year actually goes to American citizens who lack insurance. Texas continues to have one of the highest rates of uninsured residents in the U.S., with over 4 million people without health coverage. Cowles emphasized that any policy aimed at addressing rural hospital closures must consider the entire pool of uninsured patients, not just immigration-related cases. “The issue is far more complex than this bill accounts for,” she said.

The Texas Hospital Association, which reports the annual $3.1 billion figure in unreimbursed care, has not yet released a formal position on Olcott’s bill. However, their data confirms that the challenges faced by hospitals are widespread and cannot be solely attributed to undocumented populations. As the state awaits the release of the initial dataset later this week, the discussion surrounding health care access, immigration status, and hospital funding is expected to remain a key topic in Texas politics. The debate ties into broader national conversations around immigration enforcement, health care equity, and the financial sustainability of rural health systems.

Meanwhile, as legislation moves forward, advocates on both sides of the issue are mobilizing — some pushing for more transparency and accountability in taxpayer-funded health care, and others urging a more comprehensive approach that doesn’t single out undocumented patients without addressing the broader crisis of the uninsured. The results of this reporting effort, once published, will likely shape future healthcare policy debates in Texas and potentially influence other states considering similar laws.