State Senator Victor Torres represents predominantly Hispanic Osceola County in Central Florida. At Sunday mass at his local church, immigrants often tell him that they are afraid to seek medical care.
“They say, ‘My mother is sick or my child is sick, but I don’t have insurance,'” the Democrat said in an interview. “And I tell them, ‘You can’t be turned away. Go to the hospital. Don’t wait until the last minute when it’s too late.’”
Under the covenant Emergency Medical Treatment and Work Act (EMTALA), hospitals that have emergency departments and participate in Medicare – approx. 98% of hospitals in the United States – must provide emergency care to all patients regardless of their ability to pay.
However, Florida and Texas recently began requiring hospitals to ask patients about their immigration status. Supporters say the recent guidelines will highlight the costs of caring for people living in the country illegally, but critics say they are intended to discourage immigrants from seeking care.
Florida Republican Governor Ron DeSantis in May 2023 signed a sweep Immigration law This includes a provision that requires hospitals that accept Medicaid (including federal funding) to collect data on patients’ immigration status. In August, Republican Texas Gov. Greg Abbott followed suit and signed one Implementing regulation This requires public hospitals in Texas to collect data on the costs they incur to provide emergency and inpatient care to people without indefinite residency status.
“Texans should not have to bear the burden of financially supporting medical care for illegal immigrants.” Abbott said when placing the order.
Data from Texas is not yet available. In Florida, however a report from March The study by the state agency for health care suggests that undocumented patients account for a relatively compact portion of total health care spending.
In the second half of 2023, authorities found that immigrants without legal status accounted for 0.82% of hospital visits and 0.83% of emergency room visits. Florida hospitals spent a total of $69 billion in 2022. So based on those percentages, they spent about $566 million caring for undocumented immigrants.
The agency recognized that it did not know how much of that $566 million was so-called uncompensated care — that is, care that was not paid for by either insurance or the patient. Nor was there any association found between a hospital’s level of uncompensated care and its proportion of patients living in the country illegally, nor was there an apparent association between a hospital’s profitability and the proportion of its patients who were such immigrants.
In fact, the agency found that high spending on uncompensated care is more likely to be associated with a rural county than with huge numbers of undocumented immigrants.
“Research overwhelmingly suggests that immigrants do not use as much health care or receive higher levels of services than people born in the United States,” said Drishti Pillai, deputy director of the Racial Equity and Health Policy Program at KFF, a health policy research organization . Pillai recently co-authored a KFF Short version of the edition on the possible effects of the measures in Florida and Texas.
KFF has found that immigrants spend less They rely less on health care than U.S.-born residents, and some research suggests that they end up doing so Subsidizing health care other US citizens by paying insurance premiums and taxes.
In both states, hospitals must inform patients that they will receive care regardless of their answers to immigration-related questions. Florida also requires hospitals to tell patients that their responses will not be reported to immigration authorities. Still, data from Florida suggests that patients are deterred by the prospect of being asked about their immigration status.
Research overwhelmingly suggests that immigrants do not utilize as much health care or receive higher levels of benefits than people born in the United States.
– Drishti Pillai, associate director of the Racial Equity and Health Policy Program at KFF
DeSantis boasted that the policy led to a decline in Medicaid spending.
“We knew we weren’t going to get any support from the federal government, so we had to do all of these things at the state level,” DeSantis told Fox News in an interview in June. “We made sure that when people show up at the hospital we ask about their immigration status, and that has resulted in a 50% decrease in Medicaid spending in the state of Florida.”
A recent analysis of federal and state data confirms this claim. In 2022, the year before the Florida law took effect, state and federal Medicaid spending on emergency services for undocumented immigrants totaled $148.4 million. Between July 1, 2023, when the law took effect, and May 3, 2024, the total fell to $67 million, according to a Political analysis from data from the Florida Agency for Health Care Administration and the US Department of Health and Human Services. Medicaid, which provides health insurance to low-income people, is jointly funded by the federal government and states.
Florida Republican State Representative Rick Roth runs a farm and employs hundreds of migrant workers, voted for the measure. “I believe that the bill was mainly political in nature and not punitive in nature. It does not prevent them from receiving medical care. It [creates] the perception that it will be more difficult.”
Other supporters of the Florida law and Texas regulation say it makes sense to figure out how much money states are spending illegally on caring for immigrants here — and, if possible, reduce it.
“Today our health care system is being overwhelmed by illegals who have come to our country, and the costs are being borne by people like you and me who are ordinary citizens, ordinary immigrants and who came here the right way,” said Abraham George, who Chairwoman of the Texas Republican Party – and an immigrant from India – said in an interview.
“A scare tactic”
Torres, the Florida lawmaker, pointed out that most immigrants and their families take on arduous jobs, contribute to the economy and pay taxes — without receiving benefits such as Social Security, Medicaid or Medicare.
“This is Republican scare tactics against immigrants who work every day and don’t ask for handouts,” Torres said. “They go out of their way to protect themselves and their families.”
Illegal immigration is a key issue in the presidential campaign, and former President Donald Trump and other Republicans often talk about migrants straining public coffers by claiming welfare benefits. In general, these are immigrants without indefinite residence status cannot log in You receive government-sponsored health insurance under Medicaid, Medicare, or CHIP (Children’s Health Insurance Program) and cannot purchase plans under the Affordable Care Act. However, hospitals cannot turn them away in an emergency six states (California, Colorado, Illinois, New York, Oregon, and Washington) and the District of Columbia utilize federal funds to provide insurance coverage to some adults regardless of their immigration status.
In Texas, even some Democrats worry about how much hospitals and the state are spending to care for undocumented immigrants who have no insurance and can’t pay out of pocket.
“These individuals are our fellow neighbors – they should never be denied treatment or demonized by extremists. But there’s no way this can happen without funding,” Democratic Texas state Rep. Eddie Morales told Stateline.
Morales said it is legitimate for Texas to examine what it spends on caring for undocumented immigrants and that it should lend a hand hospitals pay for uncompensated care. But he accused Republicans in Washington of torpedoing a bipartisan bill aimed at addressing challenges at the border.
Long-term costs
KFF’s Pillai said the efforts in Florida and Texas could ultimately escalate those states’ health care costs as undocumented people avoid treatment but end up going to the hospital in deteriorated condition.
“This can cause routine situations to become more complex and expensive to treat later, and it can result in higher healthcare costs when a person eventually presents to the emergency room,” Pillai said.
In the brief, Pillai and her colleagues also note that undocumented immigrants play an outsized role in the workforce in Florida and Texas, particularly in sectors such as construction, agriculture and transportation.
That’s why Mike Oldham, president of the Texas Farmers Union, said he doesn’t support Abbott’s order. Oldham said such measures create a climate of fear so that migrant workers and their families who come to Texas to work are “not seen during the day.”
“We need migrant workers. If you want milk, cheese, eggs and all the vegetables, you need migrant labor,” Oldham said. “I can’t pick up white people doing these jobs. They just won’t do it.”
Oldham said requiring hospitals to ask more questions on intake forms and hire interpreters to inquire about patients’ immigration status only places unnecessary burdens on them.
Hospitals in Texas and Florida are too much fear Discussing these policies is because they don’t want to be put in the spotlight, especially when they serve people without legal status, said Deliana Garcia, program director at the Migrant Clinicians Network, a national nonprofit that focuses on health solutions for migrant groups and works with clinicians.
Garcia said the health system can either support a person when they are relatively hearty or provide more pricey care later when their condition is more severe.
Plus, she said, “you don’t want someone who’s sick to get there where they could then make you sick.”
