What is the annual cost to hospitals and medical clinics due to illegal imigration
Executive summary
Available reporting does not produce a single, definitive national dollar figure for “annual cost to hospitals and medical clinics due to illegal immigration,” but multiple credible sources converge on the conclusion that the burden is measurable in the billions of dollars per year nationally and can exceed $1 billion in single states like Texas; the precise national annual cost depends on definitions (uncompensated care, emergency Medicaid, inpatient discharges), incomplete data collection, and political framing [1] [2] [3] [4].
1. The data that exist: fragmented, state-driven, and emerging
Federal-level analyses and academic papers provide partial snapshots—Congressional Budget Office data cited in local reporting estimated $27 billion of spending between 2017 and 2023 on emergency-related Medicaid for noncitizens, which averages to roughly mid-single-digit billions per year but is a multi-year aggregate rather than a clean annual hospitals/clinic bill [1]; independent academic and policy studies highlight that emergency and uncompensated services for undocumented residents have historically been a small share of total Medicaid and national health spending (for example, a 2016 Medicaid snapshot put emergency/lifesaving spending for undocumented immigrants at about $974 million that year, a tiny fraction of total Medicaid) [3].
2. State reporting illuminates local scale—Texas as a case study
When states begin mandating hospital reporting, the numbers can look large: Texas’ new reporting under Governor Abbott’s executive order produced a figure exceeding $1 billion in hospital costs linked to people “not lawfully present” in the first year of tracking, with monthly averages reported around $105 million—figures that underscore how border states and large hospital systems can shoulder concentrated costs [5] [2]. Advocacy and policy groups in Texas offer alternative estimates—ranging from $579 million to $717 million annually for public hospital districts—illustrating variation driven by methodology, which visits are counted, and whether Medicaid-funded portions are included [6].
3. How researchers and federal rules shape interpretation
Researchers and health-policy organizations stress caveats: immigrants on average use less health care per capita than U.S.-born people (annual per-capita spending for immigrants was about two‑thirds that of U.S.-born people in KFF analysis), and many noncitizen costs are for emergency services that hospitals must provide under EMTALA and may later seek Emergency Medicaid reimbursement for—so “cost to hospitals” is a mix of reimbursed claims, unpaid bills, and charity care supported by federal/state programs [4] [7] [3].
4. Political narratives and contested estimates
Estimates diverge widely because different actors use different yardsticks: House Republican analyses emphasize billions in Medicaid emergency spending and present those as taxpayer costs [8], advocacy groups and think tanks produce higher total cost projections or fiscal summaries (some cite national totals in the tens or hundreds of billions), and local conservative groups cite monthly state report snapshots as evidence of fiscal crisis—each has an implicit agenda (federal budget framing, state political pressure, or advocacy) and methodological differences that drive the range of numbers reported [9] [10] [11].
5. Best-supported synthesis and limits of the reporting
A defensible, evidence-based answer is that hospitals and clinics incur several billion dollars a year nationally in costs tied to undocumented and other non‑insured immigrant patients, with concentrated hotspots (e.g., Texas reporting over $1 billion in one tracking year) and annual federally reimbursed emergency Medicaid outlays that are measurable but constitute a small share of total Medicaid spending; however, no single, authoritative national annual total is available in the reporting provided because of inconsistent reporting standards, partial reimbursement flows, and differing definitions of “cost” [1] [2] [3] [4]. The reporting shows clear fiscal impacts at state and institutional levels but stops short of a universally accepted national annual figure [7].