Texas Governor Greg Abbott’s Executive Order No. GA-46 takes effect on Friday, requiring Texas public hospitals to collect information on and report healthcare costs of undocumented immigrants.

Governor Abbott issued the executive order on August 8,  finding that the Biden-Harris administration is running an “open border policy” that is costing Texans by imposing higher taxes and increasing the cost of medical care by enabling undocumented immigrants to enter through the southern border and use publicly-funded medical care.

In the order, Governor Abbott specifically asserted that the administration has ignored federal laws requiring the federal government to “construct barrier infrastructure, detain illegal immigrants, vet would-be entrants, and swiftly remove aliens pressing frivolous asylum claims.” He attributes the eleven million unlawful border crossings during the Biden-Harris administration to their immigration practices.

The executive order specifically requires hospitals to collect information, including the number of inpatient discharges and emergency visits of undocumented immigrants and their resulting healthcare costs. Additionally, hospitals must report the data to the Texas Health and Human Service Commission quarterly beginning on March 1, 2025, at the latest. Furthermore, hospitals must annually report the healthcare cost(s) information collected from the fiscal year to Governor Abbott, Lieutenant Governor Dan Patrick, and Speaker of the House Dade Phelan starting on January 1, 2026.

Governor Abbott expressed in a press release:

Texans should not have to shoulder the burden of financially supporting medical care for illegal immigrants … Texas will hold the Biden-Harris Administration accountable for the consequences of their open border policies, and we will fight to ensure that they pay back Texas for their costly and dangerous policies.

Immigrant Legal Resource Center’s Senior Texas Strategist Carolina Canizales found Abbott’s rationale for the executive order to be unjustified, stating:

We know undocumented Texans contribute to the wealth of our economy. In 2022,  undocumented Texans paid nearly $5 billion in state and local taxes. So Abbott’s premise that Texans are shouldering the burden of healthcare for undocumented Texans is false … [N]early $11 billion has been wasted targeting, rather than helping, our communities of color, this includes $1 billion in COVID relief money, to fund Abbott’s Operation Lone Star.

Governor Greg Abbott explained in an official statement from 2023 that he launched Operation Lone Star in March 2021 as a military operation to stop unlawful immigration, immigration by criminals, and criminal activity occurring at the Texas southern border, which he attributed to the Biden-Harris administration’s unwillingness to enforce immigration law.

Abbott’s executive order is part of a wider conflict during the Biden-Harris administration between the federal government’s asserted constitutional supremacy over immigration matters and Texas’s asserted constitutional right to have US protection from invasion. In January 2024, the US Supreme Court found the Supremacy Clause ruled in favor of US Homeland Security agents in their dispute with Texas over the agents cutting Texas’s razor fences at the southern border. Two months later, the US Supreme Court indefinitely extended a stay blocking the enforcement of a Texas law that would criminalize unlawful immigration into the US through Texas under the Supremacy Clause.