Patient Care

Gov. Abbott stated in his executive order that “federal law contributes to the growth of uncompensated medical costs by requiring that any individual must be allowed to obtain emergency medical treatment regardless of that individual’s immigration status, or willingness or ability to pay for such treatment.” Dr. Wampler pointed out that this is important for emergency physicians because it reinforces that the executive order does not change the federal law requiring access to emergency medical treatment. As further reinforcement of this message, the executive order states that when the information is collected, hospitals should inform the patient that, as federal law requires, any response to the information request will not affect patient care.

“Operationally, it hasn’t affected us that much,” said Dr. Wampler. “Somebody’s status doesn’t really affect the medicine they receive… Emergency medicine has never performed a wallet biopsy. Emergency providers don’t make clinical decisions based on whether or not someone has health insurance.” Dr. Green agrees, explaining there was a little confusion when the question was first introduced, but now there is no pushback from patients responding to the questions.

Dr. Wampler also emphasized the separation between hospitals’ admissions personnel and medical staff. “Health care staff don’t ask those questions,” he said. He does acknowledge, however, that the fact that the questions are being asked may be counterproductive to medical care if it causes people to delay seeking care. He noted that such delays may also affect health outcomes, especially with time-sensitive medical problems, making medical conditions more difficult and expensive to treat.

Merging of Politics with Medicine

“It’s where politics meets medicine,” explained Dr. Wampler. “This is not unusual for Texas.” He noted Chapter 170A of the Texas Health & Safety Code, passed in 2022, which prohibits abortions in nearly all circumstances. Section 170A. prohibits a person from performing, inducing, or attempting an abortion. “The [Texas] abortion ban and access to emergency pain medications are examples of the intersection between medicine and politics,” he says.

Gov. Abbott emphasizes this overlap in his executive order when he specifically identified the Biden-Harris administration as adopting open-border policies that invite mass illegal entry into Texas and other states. In the executive order, Abbott referred to a May 2021 disaster proclamation stating that the surge of individuals unlawfully crossing the Texas-Mexico border posed an ongoing and imminent threat of disaster for Texas.

Gov. Abbott’s assessment of the scope of the immigration problem also appears to be at odds with official data. (Gov. Abbott’s office declined an interview with ACEP Now.) He wrote in the executive order that the number of individuals crossing the southern border had increased to 11 million people entering the country illegally in less than four years. (Factcheck.org places the number closer to 4.2 million.)² He also stated in the executive order that the Biden-Harris administration had taken steps to prevent states from addressing the crisis by destroying state barrier infrastructure and suing state officials. Moreover, he emphasized that since federal law requires emergency medical treatment, the State of Texas must absorb a large percentage of the cost for individuals not lawfully present in the United States. Texans must bear the costs of public financial support for the medical care of these individuals. Because EMTALA is an unfunded mandate, emergency physicians also bear a portion of this cost. Gov. Abbott further justified the executive order by stating that the increased expenditures for Texas hospitals impose burdens on the Texas health care system and increase the cost of medical care for all Texans.