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.