SUPPORT

HB 592 — Taxpayer-Funded Healthcare Immigration Cost Audit

Exposes the cost of illegal immigration on Idaho’s healthcare system while protecting patient privacy and access to care.

✅ Requires statewide reporting on hospital admissions by immigration status
✅ Quantifies uncompensated care tied to unlawful presence
✅ Protects patient privacy and prohibits reporting to immigration authorities

✅ Applies uniformly to Medicaid-accepting hospitals
✅ Provides lawmakers with verified, recurring cost data
✅ Establishes a factual baseline for future enforcement reform

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Introduced by Rep. Jordan Redman

Awaiting Committee Hearing (House Health & Welfare Committee.)

Bill Summary

HB 592 establishes a statewide reporting framework to measure the impact of immigration status on hospital utilization and uncompensated care in Idaho. The bill requires hospitals that accept Medicaid to ask patients to voluntarily self-report their immigration status during admission or registration and to submit aggregate quarterly data to the Department of Health and Welfare.

The department must then compile and submit an annual report to state leadership detailing hospital admissions, emergency department visits, and uncompensated care costs associated with unlawful presence. The bill includes explicit privacy protections, prohibits the collection of personally identifiable information, and ensures that patient care is not affected by immigration status disclosures.

HB 592 does not expand immigration enforcement or alter eligibility for healthcare services. Its purpose is to provide lawmakers with accurate, statewide data on healthcare system strain and costs related to unlawful presence - information that Idaho currently lacks.

Impact & Limitations

HB 592 is a measurement bill, not an enforcement bill. While it does not reduce illegal immigration, deter unlawful settlement, or change eligibility for public services, it fills a critical information gap that has allowed policymakers to avoid confronting the true costs of uncompensated care.

The bill’s impact is limited by its reliance on self-reported data and the absence of verification or enforcement mechanisms. However, its required annual reporting to elected leadership ensures that immigration-driven healthcare costs are documented, visible, and difficult to ignore. HB 592 lays the groundwork for future reforms by replacing estimates and anecdote with official state data.

Position

Secure Idaho supports HB 592.

While HB 592 does not solve Idaho’s illegal immigration problem, it represents a meaningful step toward accountability and transparency. By exposing the healthcare costs associated with unlawful presence, the bill strengthens the case for future enforcement-focused reforms and helps ensure that policy decisions are grounded in facts rather than assumptions.

HB 592 should be viewed as a foundation (not an endpoint) for immigration reform in Idaho. Secure Idaho supports the bill as part of a broader strategy to restore the rule of law, protect taxpayers, and address the downstream costs of illegal immigration through serious, enforceable policy.

HOUSE BILL NO. 592

Sixty-eighth Legislature, Second Regular Session – 2026

BY HEALTH AND WELFARE COMMITTEE

AN ACT

RELATING TO PATIENT IMMIGRATION STATUS; amending Chapter 13, Title 39, Idaho Code, by the addition of a new section 39-1397, Idaho Code, to establish provisions regarding patient immigration status data collection and to define a term; and declaring an emergency and providing an effective date.

Be It Enacted by the Legislature of the State of Idaho:

SECTION 1.

That Chapter 13, Title 39, Idaho Code, be, and the same is hereby amended by the addition thereto of a NEW SECTION, to be known and designated as Section 39-1397, Idaho Code, and to read as follows:

39-1397. PATIENT IMMIGRATION STATUS DATA COLLECTION.

  1. Every hospital that accepts Medicaid shall include a provision on its patient admission or registration forms for the patient or the patient’s representative to state or indicate the immigration status of the patient, including whether the patient is a United States citizen or lawfully present in the United States or is not lawfully present in the United States.
    The inquiry shall be followed by a statement that the response will not affect patient care or result in a report of the patient’s immigration status to immigration authorities.

  2. Every hospital shall submit a quarterly report to the Idaho Department of Health and Welfare within thirty (30) days after the end of each calendar quarter. Such report shall include the number of hospital admissions or emergency department visits within the previous quarter that were made by a patient self-reporting as:

    • a citizen of the United States,

    • lawfully present in the United States, or

    • not lawfully present in the United States.

  3. By March 1 of each year, the Department of Health and Welfare shall submit a report to the Governor, the President Pro Tempore of the Senate, and the Speaker of the House of Representatives.
    The report shall include:

    • the total number of hospital admissions and emergency department visits for the previous calendar year broken down by the three (3) categories described in subsection (2) of this section; and

    • information relating to the costs of uncompensated care for aliens who are not lawfully present in the United States, the impact of uncompensated care on the cost or ability of hospitals to provide services to the public, hospital funding needs, and other related information.

  4. The Department of Health and Welfare may promulgate rules, subject to legislative approval, relating to:

    • the format of and information to be contained in quarterly reports; and

    • the acceptable formats for hospitals to use in requesting information regarding a patient’s immigration status on hospital admission or registration forms.

    The rules may not require the disclosure of patient names or any other personal identifying information to the Department of Health and Welfare.

  5. As used in this section, “immigration status” means a person’s legal status in the United States as governed by the Immigration and Nationality Act. “Immigration status” includes the following groups:

    • (a) Individuals with citizenship who are born within the territorial limits of the United States or who have successfully completed the naturalization process after living as a permanent resident for a specified period;

    • (b) Permanent residents, including lawful permanent residents who are granted authorization to live and work in the United States indefinitely and conditional permanent residents who have gained status through marriage or certain investor programs, which status is contingent on fulfilling specific conditions;

    • (c) Nonimmigrants who are authorized to enter the United States only temporarily for certain purposes, such as students or temporary workers;

    • (d) Refugees and asylees who have been admitted to the United States as a refugee, have been granted asylum, or can provide documentary evidence that they have applied for asylum; and

    • (e) Undocumented migrants or illegal aliens who have overstayed their visa or entered the United States without authorization regardless of any temporary status they may have been granted by the Department of Homeland Security allowing them to be present in the United States.

SECTION 2.

An emergency existing therefor, which emergency is hereby declared to exist, this act shall be in full force and effect on and after July 1, 2026.

How Secure Idaho Scored this Bill

We created a scorecard to quickly show how well each bill protects Idaho's sovereignty, jobs, families, limited government, and the freedom of Idaho citizens -priorities that match what 80% of Idahoans tell us in surveys: unchecked immigration threatens our resources, wages, and values. Yet, special interests like BigAg and the Idaho Association of Commerce & Industry (IACI) often block enforcement to prioritize cheap labor over voter priorities. Our scoring flips this by building pressure through data, tracking, and county-level mobilization ahead of the 2026 session. Here's the basic system in plain English:

1) Category Criteria and Scores: Alignment with Secure Idaho's Vision

We evaluate bills against 9 key categories that embody Idaho's core values: State Sovereignty (securing independence from federal encroachment), State Culture (protecting moral values and community cohesion), Constitutional Principles (upholding separation of powers), Government Accountability (ensuring transparency), Government Size (limiting government), Government Efficiency (fighting waste), Family Success (prioritizing families), Small Business Success (supporting the American Dream), and Individual Liberty (safeguarding personal freedoms).

For each category, we ask targeted sub-questions based on bill text, data, and potential impacts:

  • Does it strengthen/enhance/improve the goal? → +1 point

  • Does it diminish/undermine/hurt the goal? → -1 point

  • Neutral or no effect? → 0 points

We average the sub-questions per category (equal weighting), then sum the 9 averages for an Overall Raw score (-9 to +9). This is converted to a 0–100 Secure Idaho Alignment Score: (Raw + 9) ÷ 18 × 100. Higher scores mean stronger alignment with protecting Idaho from unchecked immigration strains.

2) Impact Rating: The 5 Levels of Real-World Effect

Beyond alignment, we rate the bill's potential impact on a 1–5 scale, considering scope (statewide vs. limited), enforcement (penalties vs. voluntary), projected effects (e.g., reducing job/housing/welfare strains per data), blockability (vulnerable to BigAg amendments/exemptions), and precedent.

  • 1: Symbolic/Minimal (e.g., resolutions, studies - no enforcement; limited to one program/county; no teeth; easily blocked; minimal precedent). Low pressure on special interests.

  • 2: Narrow/Limited (e.g., one-sector restrictions; easy exemptions; voluntary compliance; some data tracking but weak follow-through; moderate block risk). Incremental but not transformative.

  • 3: Moderate (e.g., partial mandates with penalties; metrics for review; affects multiple sectors but with gaps; builds some precedent; medium risk of weakening). Builds momentum for county mobilization.

  • 4: Significant (e.g., statewide mandates with real penalties; direct protections for jobs/resources; hard to exempt; strong data-driven effects; counters BigAg influence). High advocacy value.

  • 5: Transformative (e.g., full E-Verify/sanctuary bans; blocks federal/H-2A overreach systemically; robust enforcement; statewide scope; sets major precedent for 2026 flips). Game-changer for sovereignty.

This rating ensures we prioritize bills with teeth over feel-good measures.

3) Bill Tier: How Alignment + Impact Determine Priority and Legislator Impact

We combine the Alignment Score (0–100) and Impact Rating (1–5) to assign a Tier (1–3), which sets a multiplier for how much the bill affects legislator scores on our dashboard. Higher alignment + higher impact = higher tier. For example: Strong alignment (80+) with transformative impact (5) might earn Tier 1; moderate alignment (50–69) with narrow impact (2) might be Tier 3.

  • Tier 1 (Multiplier: 4x – High Impact): Top priority—strong alignment, significant/transformative effects. These bills (e.g., mandatory E-Verify) heavily influence legislator scores; supporting them boosts a rep's grade, while blocking tanks it. We rally hard (petitions, rallies, county task force posts).

  • Tier 2 (Multiplier: 2.5x – Medium Impact): Solid alignment, moderate/significant effects. Worth backing but monitored for amendments (e.g., sanctuary bans). Medium weight on scores—encourages flips without overwhelming.

  • Tier 3 (Multiplier: 1.5x – Limited Impact): Weaker alignment or lower impact (e.g., studies or partial restrictions). Low weight on legislator scores—doesn't make or break a grade but tracks patterns (e.g., repeated BigAg ties). We watch/expose rather than lead advocacy.

  • Tier 4 (1x multiplier – Minimal Impact): Low alignment + symbolic/narrow impact. Mostly feel-good or toothless measures that don’t meaningfully protect Idahoans from immigration strains. Minimal or no weight on legislator scores - we note them for patterns but focus energy elsewhere (e.g., stronger bills).

Why tiers matter: They ensure high-stakes bills count more toward legislator accountability. A vote on a Tier 1 bill could swing a score by 40–80 points; Tier 3 by just 15–30. This pressures reps to prioritize voter demands over lobby donors (see our Follow the Money dashboard for BigAg PAC ties).

HB 592 scores 72 because it is a transparency and accountability bill rather than a direct enforcement measure. The bill requires Medicaid-accepting hospitals to collect and report aggregate data on patient immigration status and uncompensated care, providing lawmakers and the public with a clearer picture of the fiscal and system-wide impacts of unlawful presence. While HB 592 does not expand immigration enforcement, alter eligibility, or impose penalties, it meaningfully increases political and budgetary accountability by forcing recurring disclosure of costs that have historically remained obscured.

HB 592 relies on self-reported data and includes no verification or automatic policy trigger, which limits its immediate behavioral impact. However, by mandating quarterly reporting and annual disclosure to state leadership, the bill strengthens the Legislature’s ability to scrutinize Medicaid spending, challenge the permanence of de facto healthcare entitlements, and resist ongoing unfunded mandates associated with illegal immigration. Although it does not itself reduce illegal settlement or labor incentives, HB 592 establishes a factual baseline that can drive public pressure and future reform. As a result, the bill represents a meaningful step toward accountability, even as it falls short of the enforcement mechanisms required for structural immigration or labor reform.

Impact Rating = 2 (2: Narrow/limited scope (e.g., one-sector reporting, easy exemptions).. Tier = 3 (1.5× multiplier).

Want the full breakdown? Scroll down for the category table (every sub-question, score, average), impact notes, and tier rationale.