Opinion: In a threat to patient trust, Texas hospitals must ask 'Are you a U.S. citizen?'

As a first-generation immigrant, much of my childhood was spent in a state of perpetual uncertainty. My family and I fixated on an ever-refreshing screen, patiently watching our status shift from “H-1B visa” to “green card” holder to “citizen” over 14 long years. Yet amid this endless cycle of anxiety, one place surprisingly gave me solace: the hospital. As a long-time patient of Texas Children’s Hospital, I saw early on how health care stood apart — a field untouched by the grasp of immigration status, a space where humanity held precedence over nationality.

Beginning Nov. 1, 2024, however, hospitals across Texas are required to ask each patient the question: “Are you a U.S. citizen?” This new mandate directs hospitals to gather data on the costs of inpatient and emergency care for patients without legal status. Though patients are not obligated to respond, the act of posing the question alone carries immense weight. It turns a place of refuge into a checkpoint. For immigrants, this question plants seeds of mistrust, casting doubt over the intentions behind every health care interaction: Will we truly receive the care we need, or does the quality of that care depend on having the right papers?

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