Texas has now confirmed with hard numbers what many hardworking American taxpayers have long suspected, namely that illegal immigration is imposing a massive and still-growing financial burden on the state’s healthcare system.
Newly released figures from the Texas Health and Human Services Commission has revealed that hospitals across the state absorbed more than $1 billion in costs in fiscal year 2025 treating patients who are in the US illegally.
Those costs were compiled under an executive order issued by Texas’ Republican Governor Greg Abbott, requiring hospitals to track and report inpatient and emergency care provided to illegal aliens. The results are nothing short of astonishing—and they only cover a partial year of reporting, meaning the true cost is likely much higher.
According to the official data, more than 313,000 hospital visits were logged by illegal aliens during the reporting period. These were not isolated emergency-room encounters, but a mix of ER visits and extended inpatient stays that drove costs far beyond what most Texans would ever incur.
The largest share of the burden came from inpatient care, which accounted for well over $800 million in total costs. More than $565 million of that came from inpatient discharges not covered by Medicaid or CHIP, meaning hospitals were left holding the bag—and passing the ballooning cost along to taxpayers and insured patients.
ER visits slapped another $230 million on to the figure, further highlighting that the strain on Texas’ healthcare system is not theoretical or marginal. It is systemic, ongoing, and baked into the daily operations of Texas hospitals.
According to Federal law, hospitals are required to provide emergency care regardless of immigration status or ability to pay. In practice, that mandate means Texans who pay taxes and have health insurance are forced to subsidize healthcare for millions of people who entered the country illegally and contribute nothing toward the system that treats them.
The losses incurred by the hospitals aren’t absorbed without pain. The unpaid costs are shifted through higher insurance premiums, increased public spending, and mounting pressure on already overstretched state health programs.
Even more concerning is what the data does not include. Hospitals were only required to begin reporting in November 2024, leaving September and October uncounted. State officials have also acknowledged that submissions may still be incomplete or subject to revision.
Despite those gaps, the current figures already exceed earlier estimates. In 2021, Texas Attorney General Ken Paxton estimated uncompensated care for illegal aliens ranged between $579 million and $717 million annually—a figure now dwarfed by the most recent totals.
A closer look at the data paints a clearer picture of where the money is going. Tens of thousands of emergency room visits were billed to Medicaid and CHIP, while hundreds of thousands more were not, placing an even heavier burden on hospitals with little to no chance of reimbursement.
The highest concentration of visits occurred during the winter months, when hospitals recorded nearly 150,000 visits costing over $330 million in just one quarter. That surge mirrors broader trends tied to mass migration and strained public services.
Governor Abbott, for his part, has consistently argued that the Biden regime’s open-border policies created an unprecedented influx of illegal migrants—millions nationwide—without regard for the downstream costs imposed on states.
At the height of the border crisis, Texas alone saw roughly two million illegal entries per year when known “gotaways” are included. That scale of migration inevitably and invariably overwhelms hospitals, schools, law enforcement, and local budgets.
Abbott’s executive order was designed not only to expose the cost, but to also
build a case for federal reimbursement. Texas never agreed to fund healthcare for millions of illegal aliens, and state leaders argue Washington D.C. should be held financially responsible for policies it imposed unilaterally.
The governor also stated the issue is a matter of fairness. Working Americans who struggle to afford their own insurance, deductibles, and prescriptions are now being told they must also foot the bill for free healthcare for those who broke the law to enter the country.
Florida, which implemented a similar reporting requirement earlier, found hundreds of millions in comparable costs—although Texas’s totals are much higher, reflecting the scale of the border crisis under the Biden regime.
The broader implication is impossible to ignore. A system that guarantees free emergency and inpatient care to illegal aliens creates a powerful incentive structure—one that rewards lawbreaking while punishing taxpayers.
The data also countersignals spurious claims that illegal immigration is a net benefit to public finances. Whatever economic activity illegal migrants may generate is quickly eclipsed by the immense and recurring costs imposed on essential public services.
