Editorial: Hospital citizenship mandate compromises public health just to make political points

As of Nov. 1, Texas hospitals now are required to ask patients for their citizenship status. It’s the latest publicity stunt by Gov. Greg Abbott that might be intended to score points with President-elect Donald Trump and other Republican Party xenophobes, but it’s unlikely to provide any real benefit while putting at risk any people needing medical services who might be scared off by the question.

Abbott issued an executive order Aug. 8 requiring hospitals to begin collecting data on the citizenship of people they attend. The hospitals will have to start providing quarterly reports with that information beginning in March.

The governor said he wants the data to see how much hospitals spend on medical care to non-citizens, and suggested he plans to bill the federal government for those costs.

“Texans should not have to shoulder the burden of financially supporting medical care for illegal immigrants,” Abbott said when he announced the order. He said any facilities that don’t comply could lose state Medicaid funding, which is about 30% of the total cost of the federally run program.

It’s worth noting that the state already turns down more than $5 billion a year in federal Medicaid funding that is offered through the Affordable Care Act, which Abbott opposes.

Donald Trump’s election also could make it harder for Abbott, a Trump acolyte, to collect federal money, since Trump has expressed the same aversion to using taxpayers’ money to pay for immigrant services.

The net effect might not be significant, since the public funding to which the governor is looking comes out of the same taxpayers’ pockets, whether it’s collected by the state or the federal government.

Analysts also have suggested that the data collected might be of little use. Apparently it doesn’t adequately determine how many non-citizens’ services are paid through other government programs, private insurance or out of pocket.

Rio Grande Valley hospitals, for examples, receive several patients from Mexico who come for specialized care and who have the means to pay for that care.

Florida Gov. Ron DeSantis signed a similar order in 2023, and reports indicate that the data showing the cost of immigrant care doesn’t take into account patient payments that reduce the hospitals’, and state’s, share of that cost.

The Texas Hospital Association has made it clear that hospitals are required by law to provide life-saving care to everyone, regardless of their legal status or ability to pay. However, it could scare away people who need medical services and put their health at risk. The order would serve the same purpose as the old tactic some centers employed — fortunately mostly abandoned — of dressing private security guards in green uniforms that looked like those worn by Border Patrol agents in order to deter unwanted immigrants.

A THA spokesperson also noted that patients should have a right to refuse to answer a question about their citizenship, although many might know it.

Abbott’s order might score political points with close-the-border advocates, but any benefits to the public are far outweighed by the threat to anyone who doesn’t seek the medical care they need.

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