McALLEN, TEXAS, USA —
For three days, staff at an Orlando medical clinic encouraged a woman with abdominal pain who called the triage line to go to the hospital. She resisted, frightened by a 2023 Florida law that requires hospitals to ask whether a patient is in the U.S. legally.
The clinic had worked hard to explain the limits of the law, which is part of Gov. Ron DeSantis’s broader package of stricter immigration policies. The clinic posted signs advising patients that they could decline to answer the question and still receive care: Individually identifying information would not be reported to the state.
“We tried to explain this over and over and over again, but the fear was real,” said Stephanie Garris, CEO of Grace Medical Home, adding that the woman eventually went to an emergency room for treatment.
Texas will be next to test a similar law for hospitals enrolled in state health plans, Medicaid and the Children’s Health Insurance Program. It will take effect Nov. 1, just before the end of a presidential election in which immigration is a key issue.
“Texans should not have to bear the burden of financially supporting the health care of illegal immigrants,” Greg Abbott, the Republican governor of Texas, said in a statement announcing his mandate, which differs from Florida’s in that providers do not have to inform patients that their status will not be shared with law enforcement.
Both states have large numbers of immigrants, ranging from people who are in the United States without legal permission to people who have pending asylum cases or are part of mixed-status families.
And while the uninsured rate in these two states — neither of which has expanded Medicaid coverage — is higher than the national average, research has shown that immigrants tend to use less and spend less on health care.
Texas and Florida have a long history of defying federal immigration policies by passing policies of their own. And their Republican leaders say the hospitality laws counter what they see as lax border enforcement by President Joe Biden’s administration, though they themselves admit that early data from Florida is limited.
Blaise Ingoglia, the Republican state senator from Florida who sponsored the hospital bill, said in a written statement that the law is “the strongest and most comprehensive state-led anti-ILLEGAL immigration law” but did not respond to AP’s questions about the law’s impact on the immigrant community or hospitalized patients.
Luis Isea, an internal medicine physician with patients in hospitals and clinics in Central Florida, said the law “creates that additional barrier” for patients who are already exposed to many disparities.
Immigrant advocacy groups in Florida said they sent thousands of text messages and emails and held clinics to help people understand the limitations of the law, including the fact that law enforcement agencies would not know a person’s status because the data would be reported in aggregate.
But many of the calls went unanswered. Some patients reported leaving Florida as a result of the law’s impact on accessing health care and employment.
The DeSantis administration tied the hospital mandate to other initiatives that invalidated some driver’s licenses, criminalized the transportation of immigrants who lacked permanent status and changed employment verification policies.
Others, advocates say, resisted their pain or had to be coaxed. Veronica Robleto, a 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 young woman who was not legally allowed to be in the United States and feared she would be separated from her child if she gave birth in the hospital.
“He was very scared (but) he ended up coming after talking to me,” Robleto reported.
The data Florida and Texas collect will likely be unreliable for several reasons, researchers suggested. Paul Keckley, a health economist, said the report released by Florida state officials may contain “incomplete, inaccurate or misleading” data.
For one, it’s self-reported. Anyone can decline to respond, an option chosen by nearly 8% of people admitted to the hospital and about 7% of those 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 admitted to the hospital reported being in the United States “illegally.”
The Florida Agency for Health Care Administration acknowledged major shortcomings in its analysis, saying it did not know how much of the care provided to “illegal aliens” went unpaid.
He also said he could not link high levels of unpaid care to the level of “illegal aliens” arriving at a hospital, adding that they are “more associated with the status of rural counties than with illegal immigration rates.”
The agency did not immediately respond to requests for comment and more information. Its report noted that for much of the past decade, the number of unpaid bills and uncollected debts owed by Florida hospitals has been declining.
In Florida and Texas, people who are in the United States illegally cannot enroll in Medicaid — the public health insurance program for people with low incomes or resources — except in the case of a medical emergency.
Multiple factors can affect the cost of care for people who are in the United States illegally, experts said, especially a lack of preventive care. That’s especially true for people who have progressive diseases like cancer, said Dr. James W. Castillo II, health authority for Cameron County, Texas, which has about 22 percent of its uninsured population compared with the state average of 16.6 percent.
At that point, he said, “it’s generally much more difficult to treat, much more expensive to treat.”
Texas community groups, lawmakers and immigration attorneys are partnering with Every Texan, a nonprofit that focuses on public policy and access to health care, to encourage people not to answer the question about their status, said Lynn Cowles of Every Texan.
And in Florida, even as deportation fears ease, questions remain about the law’s purpose.
“How much of this is substantive policy and good politics versus how it fared, I’ll leave that for others to speculate,” said Garris, of the Orlando clinic. “But I know that the practical effect of the law was egregious and degrading to the patients who live here, who work here. It’s just insulting.”
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