McALLEN, Texas (AP) — For three days, staff at an Orlando medical clinic urged a woman with abdominal pain who called the triage hotline to go to the hospital. She resisted, fearing a 2023 Florida law that would require hospitals to ask whether a patient is in the U.S. legally.
The clinic had gone to great lengths to explain the limits of the law, which was part of Gov. Ron DeSantis’ sweeping package of stricter immigration policies. The clinic posted signs and advised patients: They could refuse to answer the question and still receive treatment. Personal, identifying information would not be shared with the state.
“We tried over and over to explain it, but the fear was real,” said Stephanie Garris, CEO of Grace Medical Home, adding that the woman eventually went to the emergency room for treatment.
Next, Texas will test a similar law for hospitals that are part of state health insurance, Medicaid and the Children’s Health Insurance Program. It will take effect on November 1, just before the end of the presidential election, in which immigration is a key issue.
“Texans should not have to bear the burden of funding the medical care of illegal immigrants,” Republican Texas Gov. Greg Abbott said in a statement announcing his fresh rule, which differs from Florida’s in that providers do not have to tell patients that their status will not be disclosed to authorities.
Both states have high numbers of immigrants, from people who are in the U.S. without legal permission to those whose asylum cases are pending or who are part of mixed-status families. And while the number of people with health insurance in these two states — neither of which has expanded Medicaid — is higher than the national average, research has shown that immigrants tend to exploit and spend less on health care.
Texas and Florida have long sought to challenge the federal government’s immigration policies through their own laws, and their Republican leaders say the hospital laws are a counter to what they see as lax border enforcement by the Biden administration – although early data from Florida says it is confined.
Blaise Ingoglia, a Republican state senator from Florida and a sponsor of the hospital bill, said in a written statement that the bill is “the strongest and most comprehensive federal law against illegal immigration.” But he did not respond to questions from The Associated Press about the impact of the bill on the immigrant community or on hospital patients.
Luis Isea, an internist who treats patients in hospitals and clinics in Central Florida, said the law “creates this additional barrier” for patients who already face many inequities.
Immigrant advocacy groups in Florida said they have sent thousands of text messages and emails and held seminars to explain to people the limitations of the law, including that law enforcement would not know a person’s status because the data is only reported in aggregate form.
But many calls from health care workers went unanswered. Some patients said they were leaving Florida because of the law’s impact on health care and employment. The DeSantis administration linked the hospital requirement to other initiatives that invalidated some driver’s licenses, criminalized the transportation of immigrants without eternal residency status and changed employment verification policies.
Others, advocates say, were in pain or had to be coaxed. Verónica Robleto, program director at the Rural Women’s Health Project in north-central Florida, received a call before the law took effect in July 2023 from a newborn woman who was not legally allowed to be in the U.S. and feared she would be separated from her child if she gave birth in the hospital.
“She was very scared, but finally went after talking to me,” Robleto said.
Whatever data Florida and Texas collect is likely to be unreliable for several reasons, researchers said. Health economist Paul Keckley said the report released by Florida state authorities may contain “incomplete, inaccurate or misleading” data.
First, it’s self-reported. Anyone can refuse to answer, an option chosen by nearly 8% of people hospitalized and about 7% of people who went to the emergency room between June and December 2023, according to the Florida state report. Less than 1% of people who went to the emergency room or were hospitalized reported being in the U.S. “illegally.”
The Florida Department of Health admitted major flaws in its analysis. It said it did not know how much of the treatment of “illegal aliens” went unpaid. It also said it could not link the high number of unpaid treatments to the number of “illegal aliens” entering a hospital. It said this was “related to the status of rural counties rather than the percentage of illegal immigrants.”
The agency did not immediately respond to requests for comment and further information. Its report states that the number of unpaid bills and uncollected debts at Florida hospitals has declined over the past decade.
In Florida and Texas, people who are not legally in the U.S. cannot enroll in Medicaid, which provides health insurance for low-income people, except in the event of a medical emergency.
Experts say several factors can affect the cost of treating people who are in the U.S. illegally, particularly the lack of preventive care. That’s especially true for people with progressive diseases such as cancer, said Dr. James W. Castillo II, the health commissioner for Cameron County, Texas, where about 22 percent of the population is uninsured, compared to the national average of 16.6 percent.
At this point, he said, “treatment is usually much more difficult and much more expensive.”
Civic groups, policymakers and immigration attorneys in Texas are working with Every Texan, a nonprofit focused on public policy and health care access, to encourage people not to answer the status question, said Lynn Cowles of Every Texan.
And in Florida, while fears of deportation are waning, questions about the purpose of the law remain.
“How much of this is substantive and good policy and how it played out, I’ll leave that to others to speculate on,” said Garris of the Orlando clinic. “But I do know that the practical effects of the law have been outrageous and degrading to the patients who live and work here. It’s just an insult.”
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Salomon reported from Miami and Shastri from Milwaukee.
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