According to supporters of the legislation, hospitals routinely absorb billions of dollars in uncompensated care each year, yet there has never been a federal requirement to identify how much of those expenses are associated with patients who are unlawfully present in the United States.
Without standardized reporting, lawmakers have largely relied on estimates, state-level data, and independent research organizations to calculate the burden placed on taxpayers.
Roy says that lack of information has allowed Washington to avoid confronting the issue.
The effort follows reporting systems implemented by Republican governors in two of the nation’s largest states.
In 2023, Florida Gov. Ron DeSantis signed legislation directing hospitals to ask patients about their immigration status during registration and submit quarterly reports to the state.
State data later estimated that hospitals provided approximately $566 million in care connected to illegal immigrants during the program’s first year.
Texas adopted a similar approach under Gov. Greg Abbott.
State officials reported that hospitals recorded 313,742 patient visits involving individuals not lawfully present in the United States during fiscal year 2025. Those visits were estimated to cost taxpayers roughly $1.05 billion.
Supporters also note that the Texas figures likely represent only a partial picture because mandatory reporting did not begin until November 2024, leaving the first two months of the fiscal year outside the reporting period.
Roy’s proposal would extend those reporting requirements to hospitals throughout the country that participate in federal healthcare programs.
Under the legislation, hospitals receiving federal healthcare funding would ask patients about their immigration status during the intake process.
The bill emphasizes that patient responses would not determine whether treatment is provided and would generally not be shared with law enforcement authorities. An exception would apply in cases involving individuals suspected of or charged with criminal offenses.
Hospitals would then submit quarterly reports to both the Department of Health and Human Services and the Department of Homeland Security.
In addition, the Secretary of Health and Human Services would be required to deliver an annual report to Congress every October summarizing the nationwide costs associated with treating patients who are in the country illegally.
The legislation also includes a significant enforcement mechanism.
Hospitals that refuse to comply with the reporting requirements would risk losing eligibility for federal healthcare funding.
Roy argues that Americans have paid these costs for years without being given access to reliable data.
“Federal taxpayers should be privy to the costs of illegal aliens admitted to hospitals that accept federal healthcare subsidies,” the bill summary states. “American taxpayers ought to know the full scope of how much they pay for illegal aliens’ healthcare costs.”
The Texas congressman also expanded on the purpose of the legislation during an interview with Breitbart News.
“For years, Americans have watched overcrowded emergency rooms, rising healthcare costs, and strained hospital resources while being kept in the dark about the potential billions of taxpayer dollars spent on healthcare for those who are in the country illegally,” Roy told Breitbart News.
“That lack of accountability is unacceptable and absurd,” Roy continued. “The Illegal Alien Patient Reporting Act delivers the transparency and accountability Americans deserve by ensuring hospitals report the extent to which illegal aliens are adding to the fiscal burden of our healthcare system.”
Because no nationwide reporting requirement currently exists, estimates of the total cost vary considerably.
Organizations advocating for stronger immigration enforcement have argued that the financial burden reaches into the tens of billions of dollars annually.
The Federation for American Immigration Reform (FAIR), for example, estimates that healthcare expenses tied to illegal immigration exceed $40 billion each year when broader population estimates are included.
Supporters of Roy’s legislation argue that official reporting would replace competing estimates with verified nationwide figures, allowing Congress and the public to evaluate the issue using consistent government data rather than projections.
The proposal is also expected to fuel a broader debate over immigration policy heading into future legislative battles.
RJ Hauman of the National Immigration Center for Enforcement argued that opponents of the legislation should welcome greater transparency if they believe illegal immigrants contribute enough economically to offset public costs.
“If Democrats and their sanctuary allies really believe illegal aliens ‘pay their way,’ they should have no problem proving it,” Hauman said.
Whether the legislation advances in Congress remains uncertain, but supporters say its primary goal is straightforward: requiring the federal government to collect information that has never before been systematically reported nationwide.
If enacted, hospitals participating in federal healthcare programs would submit regular reports, Congress would receive annual nationwide summaries, and taxpayers would have access to official figures that have long remained unavailable.
