Fear in the ER: Why scaring patients won’t fix health care spending
Fear in the ER: Why Scaring Patients Won’t Fix Healthcare Spending Heading link
By Rafael Torres
Opinion Editorial
On Aug. 8, 2024, Texas Governor Greg Abbott signed Executive Order GA-46, requiring emergency rooms to ask all patients about their immigration status. Gov. Abbott claims this measure aims to assess health expenditure costs in response to President Biden’s “open-border” policies.
This executive order appears redundant, as credible estimates already exist regarding health care utilization and spending by undocumented immigrants. The underlying motives behind this order seem twofold: to suggest that undocumented individuals impose a financial burden on Texas and the nation, and to instill fear among undocumented immigrants seeking emergency medical care. This politicized strategy may backfire.
How much do undocumented immigrants spend on health care? According to the Congressional Budget Office, Medicaid spent $16.2 billion dollars on emergency medical services for undocumented immigrants since President Biden took office. This works out to be around $5.4 billion dollars a year. For context, total U.S. health care spending in 2023 was calculated to be $4.9 trillion. So, doing a simple calculation, undocumented immigrants accounted for 0.036% of total health care spending in 2023 while making up 0.03% of the population.
Now, let’s examine the contributions of undocumented immigrants to the U.S. economy. According to the Institute on Taxation and Economic Policy (ITEP), undocumented immigrants paid $96.7 billion in federal and state taxes. The same study breaks this down and specifies that these figures contribute $25.7 billion towards social security and $6.4 billion towards Medicare. They cite that in 40 states, undocumented immigrants actually pay a higher tax rate than the top 1% of earners. In Texas specifically, ITEP reports that undocumented immigrants paid $4.87 billion in taxes. If these immigrants had legal status, their tax contributions would increase to $5.34 billion, a significant difference of about $500 million.
Considering these facts, what are the potential ramifications of Executive Order GA-46 on the undocumented immigrants of Texas? Based on my own lived experience growing up in a family of undocumented immigrants, many will delay seeking emergency medical services out of fear and distrust of the Texas health care system as a result of this executive order. This will only lead to worse health outcomes for an already underserved community. Sicker patients will no longer walk into the emergency room but show up in an ambulance. As a result, the cost of providing care can increase. Since undocumented immigrants are much more likely to lack health insurance, the cost will fall back on the taxpayer, many of whom are undocumented immigrants themselves.
Requiring individuals to disclose their immigration status in emergency rooms will discourage necessary medical care. Undocumented immigrants do not significantly burden health care costs and contribute billions in tax revenue, benefits from which they rarely benefit. When delayed medical care eventually occurs, patients will likely be sicker, resulting in worse outcomes and higher care costs. This executive order, purportedly to assess the health care burden of undocumented immigrants, addresses an issue that is already well-documented and understood.
Abbott, an experienced politician, aims to demonize hardworking people seeking a better future for their families, much like the ancestors of every American.
Abbott’s attempt to scapegoat hardworking people not only misrepresents the facts, but also ignores the vital contributions of undocumented immigrants to the economy.
Rafael Torres is an M3 at UICOMR
rafaelt3@uic.edu