Advocates Race to Inform Immigrants, Hospitals as Abbott Demands Citizenship Reports

By Madeline de Figueiredo

Reporting Texas

In the leadup to the Nov. 1 implementation of Gov. Greg Abbott’s executive order requiring Texas public hospitals to report on health care for undocumented immigrants, advocacy groups raced to inform affected communities and providers about the policy’s implications and limitations.

Abbott issued an executive order in August directing the Texas Health and Human Services Commission to collect data on health care costs incurred by undocumented immigrants, aiming to seek reimbursement from the federal government for these expenses. Abbott has framed this policy as a way to hold the Biden administration accountable for expenses related to federal border policies. The order mandated that public hospitals inquire about patients’ citizenship status starting Nov. 1 and report expenses quarterly and annually to state officials.

“Hospitals are required by the executive order to ask about immigration status; however, patients are not required to answer the question,” said Tania Chavez Camacho, executive director of La Union del Pueblo Entero, one of the advocacy organizations mobilizing to inform patients about their rights under this new policy.  

Texas has an undocumented population estimated at 1.6 million, according to Pew Research Center. Undocumented immigrants in Texas already face major healthcare access gaps, as they are ineligible for Medicaid, CHIP and health care insurance subsidies, relying instead on limited, inconsistent and location-based options at health centers and charity clinics.

Advocates worry the executive order will have a chilling effect on immigrants’ access to health care, further exacerbating these gaps. 

“Immigrants will avoid seeking out medical care and treatment for injuries at the hospital because of fear that there will be some kind of retaliation and information sharing,” said Lynn Cowles, the health and food justice programs manager at the nonprofit Every Texan. “This will definitely increase the chilling effect and our concerns are primarily that people will remain sick and injured because they won’t go to the hospital.” 

Every Texan and La Union del Pueblo Entero are two major advocacy groups working to inform immigrant communities and providers about the scope of the order and patients’ rights.  

LUPE has criticized the governor’s actions for potentially deterring immigrants from seeking health care, advising community members to decline answering citizenship questions and encouraging people to seek support from LUPE and other organizations if they feel they are being treated unfairly. 

“I think it is absolutely in the best interest of the community for everyone to decline these questions,” Chavez Camacho said. “We want to make sure that community members understand that they should not stop seeking medical care out of fear and that they have a right not to answer the question.”  

Every Texan is partnering with other organizations to distribute memos to community-based organizations and providers with guidance on how to engage with the order. 

“There’s a lot of policy advocacy still to come, but we are also working with communities to try to get them the best information and the most timely information about how to respond to this question and what should happen if you decline to answer, in which case there shouldn’t be any impact to one’s health care,” said Erin O’Malley, a senior policy analyst with Every Texan. 

Every Texan is also encouraging all people, regardless of their status or background, to decline responding to the question about documentation status. 

“It’s a technique or strategy in solidarity with immigrants across Texas for citizens, green card holders, everybody to decline to respond to those questions,” Cowles said. 

“If an immigrant goes to the hospital and declines to respond, then because everybody else has declined to respond, then the potential effects of a bad actor or an uninformed actor would be less significant on that immigrant or mixed-immigration-status family because everyone else is also declining to respond,” Cowles said. 

Harris Health, the Houston public health care safety-net provider that Ben Taub Hospital, said patients’ personal information would not be shared and all people, regardless of citizenship status, will be able to access health care through their hospital system. 

“We want to assure all of our patients and community members that no personal information will be shared by Harris Health with the state or other agencies as a result of the requirement,” Harris Health said in a statement to Reporting Texas assuring that the system will fully comply with the reporting requirements. “Regardless of how (patients) answer the citizenship status question, it will in no way interfere with their receiving health care at Harris Health emergency rooms or hospitals.”

While many other public hospital systems declined to comment, the Texas Hospital Association, the principal advocate for the state’s hospitals and health care systems, also said the order should not interfere in patient care.

“The most important aspect for us is that patients understand this will not impact the hospital care they receive,” said Carrie Williams, chief communication officer at the Texas Hospital Association, declining to comment further. 

Abbott said his policy will hold the Biden administration accountable for its immigration policies. “Texans should not have to shoulder the burden of financially supporting medical care for illegal immigrants,” Abbott said in the executive order.

But advocates said the order will never effectively gather the cost data that Abbott is seeking and instead has left its mark as a threat to undocumented communities. 

 “We’ll never be able to understand what types of costs immigrants or other people are incurring in hospital settings because there is no way to implement this executive order effectively,” Cowles said. “It doesn’t serve a purpose as a data gathering tool. … It really is just creating an inhospitable environment in this state for immigrants. Ultimately, tt’s a bad-faith effort to threaten immigrant communities.”