Peter Drucker, the guru of modern business theory and practice, once observed, “You can’t improve what you don’t measure,” advice that has become the mantra of any CEO responsible for financial sustainability. Of course, taking inventory of things as a first step toward improving them is nothing new, nor is it limited to industry. America’s Founding Fathers understood that effectively managing their new nation required some measuring too. It’s why the U.S. Constitution specifies that a periodic count of the population be undertaken for the purpose of legislative representation. That information also helps identify national and local trends and determines how and where government resources are spent.
Likewise, Florida and Texas have been doing some bean-counting of their own as a matter of responsible public administration. The governors of those states have recently put in place a process to assess the cost of uncompensated health care imposed on taxpayers by illegal aliens residing in their states.
In May of 2023, Florida Governor Ron DeSantis signed SB 1718, which, among other provisions, requires hospitals that accept Medicaid to inquire about immigration status on patient admission forms. That information is collected and used to calculate the annual cost of health care that illegal aliens are getting for “free.”
The results are in, and it’s not good news for Florida taxpayers: Uncompensated care for illegal aliens in 2024 cost Florida taxpayers $660 million. While staggering, the figure is likely even higher, given that answering the immigration status question is voluntary. Indeed, many hospitals report that over half their ER patients declined to answer it. Figures for 2025 are expected to be released later this year.
Texas Governor Greg Abbott also understood the urgency of getting a handle on things when he signed an executive order in August of 2024 requiring all public hospital providers to inquire about the immigration status of each patient. Like Florida, the figures are shocking: Uncompensated health care extended to illegal aliens cost Lone Star State taxpayers $1 billion in 2025. And, just like Florida, that figure is likely low because answering the question is also voluntary in Texas.
For politicians, delivering bad news to voters is about as much fun as passing a kidney stone. Kudos to Governors DeSantis and Abbott for admirably disclosing the costs rather than ignoring, hiding, or lying about them, as many other public officials often do when it comes to anything immigration-related. Both understood that counting was a necessary step. After all, Florida has 1.6 million illegal aliens, almost half of them uninsured, and up until recently, no one really knew what their health care cost taxpayers, as evidenced by a Miami Herald article at the time pondering “How much do undocumented patients cost Florida’s hospitals?” Texas has it even worse, with 2.7 million illegal aliens. And, until recently it had an unsecured U.S.-Mexican border with surging migrant flows posing existential threats to the solvency of the state’s social services.
None of that, however, makes a lick of difference to immigrant special interest groups who don’t like the new question hospitals are asking.
Referring to the Florida hospital immigration question, Drishti Pillai, director of immigrant health policy at the Kaiser Family Foundation, said, “These restrictions are creating a climate of fear in the state. Increased fears among immigrants … will have some blood-chilling effects by leading immigrant families to avoid seeking health care not only for themselves, but also for their children who may include U.S.-born citizens, just out of fear of drawing attention to their immigration status.”
More accurately, Ms. Pillai herself seems to be creating a “climate of fear.” The “restrictions” are in fact simply questions, and no one will be denied care if they decline answering. The hyperbole is no surprise, though; she’s part of the Kaiser umbrella, which includes KFF, a left-leaning health care research organization that largely dismisses the cost of illegal alien health care to taxpayers because – get this – government payments substantially offset the cost of uncompensated care for the uninsured.
That’s right, costs just magically disappear because, you know, it’s the government paying.
To be clear, no one in Florida, Texas – or anywhere in America – should fear asking for emergency medical treatment. The Emergency Medical Treatment and Active Labor Act, enacted in 1986, requires hospitals to accept and stabilize every patient in an emergency situation, regardless of immigration status.
This reality, of course, is omitted from the narratives of those who oppose Florida and Texas’s new policies designed to evaluate just how taxpayer money is being spent.
Governors DeSantis and Abbott aren’t denying services to those in need, but they are doing some common-sense counting of costs. Doing so helps their state officials manage limited resources. Equally important, disclosing costs helps citizens understand more fully the impact of illegal immigration, why robust enforcement is taking place, and why it is long overdue.
As for the 48 other states that have yet to replicate Florida and Texas’ cost-counting process, it would seem Drucker’s sage advice that “You can’t improve what you don’t measure” has been corrupted into “You can hide what you don’t measure.”
Dale L. Wilcox is executive director and general counsel at the Federation for American Immigration Reform in Washington, D.C.
The opinions expressed by columnists are their own and do not necessarily represent the views of AMAC or AMAC Action.
Funny that democrats spend a whole lot of time and trouble trying to make us believe that “undocumented immigrants” never receive free healthcare. Or SNAP. Or housing benefits. Or…
It is definitely a wakeup call for taxpayers. Illegals get health care for free while the seniors are now forced to pay on their Part B payment – triple. My friend who started taking Eliquis just a few months ago now has to pay upfront her deductible which is $690.00!! She will get 3 bottles of medicine for 3 months, if she only gets one bottle it would be $300.00. How is this even fair to Americans. Seniors should not have to decide if they get their food or their medicine because they can’t afford both. I also read an article about the drug companies raising their prices on 350 drugs and that they don’t care what President Trump said about lowering drug costs!
Excellent article. And it needs to be shown on the national stage. You can’t hide the facts.
This is not a surprise, when millions uninvited arrive at the door, they need to be housed, fed, schooled, medicated and it costs mega dollars, they do not contribute, drain on the pocket, maybe those who invited and encouraged them to come in and are fighting for then now should be charged for what they’ve done. make them pay for their upkeep with the money they’ve got from the tax payer, mostly from the craftiness. Put the Clinton and Obama foundations to work, never mind the Obama mausoleum or whatever it is he is building, make it into a housing for the less fortunate.
I can imagine how this frustrates the tale of hiding the cost of the “free benefits” story. I am not saying deny medical care to anyone, but what I am taking about is how just like those “student loans” are covered by the government program with no limits on what will be reimbursed because Congress somehow thinks it’s discriminatory to do this in a financial solvent process. Congress does this because they aren’t contributing the funds, and they think they can just spend the taxpayer money with no documentation auditing of the amounts spent. And meanwhile, those of us, who have to pay those copays don’t get discounts on our costs besides still paying taxes and premiums for our healthcare. Plus it would be beneficial to encourage well care programs to lower the amount of people, hopefully, who would need extra care from not taking care of themselves properly.
While I don’t advocate letting people die in the streets free healthcare is not free. Those of us who pay taxes and live in the state that is providing the “free” healthcare have to pay for it. I recently retired and that has cut my pay almost in half. I pay my healthcare 2 times per year. This year the 2nd payment jumped significantly from the time it was quoted to the time it came to pay it. I can’t afford to pay for the the onslaught of illegals dragged into the country by the Biden administration. And, I am sorry if that offends people. How about the people who shuttled those folks into the country foot the bill. How about all those politicians that made this possible, give up their ill-gotten gains from insider trading (and God knows what else) to pay for it. America is a country, countries require borders and citizens can not afford to pay for unchecked immigration. This whole situation is so shameful. I have known for at least 45 years that our government is wasteful and corrupt, but really, I never thought it would be this bad in such a short time.
I have seen poverty and I understand why people want to get out of it. However, breaking our laws so as to get out of where you came from and making me pay for it, is wrong. I would not open my door willingly to a known thief and then tell them to take everything I own. We do this daily though, we have allowed people to Illegally come into our house, take money we have earned for my family, and made me pay for the privilege. ENOUGH! Democrats have said of our future, “You will own nothing and be happy”. That is exactly what 3rd world countries told their people and that is why those same people have broken into our house to own what we have. We are expected to give them what we will no longer own. Are you and your family “Happy” about it.
Actually none of this is a big surprise
Wow – thank you for this Great article clearly explaining the costs associated with NOT having a secure border or an well thought out immigration policy in Our Country.
Although designing and instituting this immigration legislation is hard work, requires diligent pursuit and necessitates cooperation, we do pay politicians and an enormous support staff at local,state and the federal level who should be capable of creating and employing such a measure.
ALL states should mandate certain items, a balanced budget, and TRUE TRANSPARENCY that shows incoming revenue and EXPENSES (detailed accounting of what it paid for) and ANY politician or taxpayer paid bureaucrat not compliant or unwilling needs to GO!
Wake up People – don’t forget the waste and corruption that President Trump is exposing, and there have been MANY with their hands in the Citizens cookie jar!!
Time to END IT!
I’m become almost enraged when I hear of fraud and corruption, and just as enraged when I hear anybody refer to health care as a “right”. It’s not a right, it’s a privilege and we pay for that privilege. Nothing that someone else has to provide to you is a right. We have the right to own guns if we want to, that doesn’t mean that the ubiquitous and mysterious “They” will provide you with a gun, you have to earn legal access by not being a criminal, or an illegal inhabitant of the USA, and you have to pay for it.
The same stands for healthcare. You have the right to seek healthcare, but you don’t have a right to have it be given to you. You have to pay for it. Many illegals don’t pay for their keep in any way—not by sacrificing for this country and the freedoms those sacrifices provide through military service, not by allegiance, apparently not by working as recently revealed in the Somali immigrants, and largely, not by paying taxes. If illegals took all the energy, money and manipulation it takes to come and live in the USA illegally, and put that into making their own country better, perhaps sacrificing something, anything, for their own country, maybe they’d have a better country.
They won’t sacrifice of themselves, or send their children to war for wherever they came from, why would they do anything for my country? My mind’s image is they largely just take up space, use up resources, engage in fraud and act as a catalyst to the decay of American culture, imposing their home countries’ practices on Americans.
Our culture is unique in that it is set up so that you can fully embrace being American while still keeping the uniqueness of your own cultural identity where it doesn’t interfere with Americanism. Try going to any other country and be American in that country! Insulting us even more is this truth that Illegal Alien immigrants are being provided with free healthcare. It is infuriating when American citizens have to “sacrifice” for the same care. We should bill the countries of origin to recover the cost for providing care to their citizens. That’s a good idea, get accurate information and bill their own country. We should never be dissuaded from insisting on being able to determine who exactly is in front of us. We have to require accurate information of all people receiving healthcare, benefits, voting, attending schools, etc. Most Americans wouldn’t even think of lying, or withholding information when requesting care, or services for free, so the withholding of such information is a sure sign deceit is at play.
I hope this administration gets ALL the immigration problems fixed, and fast. So far, the many, many infuriated citizens on the right (side) will reach their own breaking point. There is no such thing as social justice and trying to impose equality through a concept of equity repeat with handouts for the underserving (not underserved) is contrary to human nature and only promotes the majority turning into the lowest common denominator. It’s unAmerican.
Whatever it takes, we MAGA people believe in, and insist on a fair, merit based system that ONLY takes care of OUR most vulnerable CITIZENS. Individuals are free to allocate their own resources however they want, but it’s not up to a few people to decide to spend taxpayer dollars on their personal agenda. Enough with the handouts! As if anybody is really trying to heal the world. Human nature says that at the top of it all is plain and ugly self-interest of the few imposed upon the so-called masses and confusing the hell out of the meager, who morph into what is known as progressives, which is typical because everything is called the opposite of what it really is with this group of eternally confused people.
Every US citizen should refuse to pay. The hospitals will notice.
Since immigration is a Federal responsibility all the costs at state level should be filed in lawsuits against the Feds.
Just a thought if the children are US Citizens then what’s the problem.!!
no replies needed not up for argument and no one is refused care so who can be mad at being ask