The Supreme Court ruled 6-3 last month in Trump v. Barbara that “children born in the United States to parents unlawfully or temporarily present” are “citizens at birth.” But at a moment in which even Pew Research is confirming that nearly 1 in 10 American births in 2023 were to parents living here illegally or on temporary status, the issue of birth tourism is gaining traction.

Birth tourism remains particularly notable in Texas. Governor Greg Abbott announced on July 7 that the state would be investigating Rio Grande Valley-based Mission Regional Medical Center for purposefully advertising “Birth Packages in South Texas.”

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Former Texan Congresswoman Mayra Flores brought attention in April to Spanish-language billboards across the Mexican border, advertising a website called “HavemybabyinTEXAS.com.” The signs included packaged deals, with natural births starting at $3,950 and C-sections for $5,525. A subsequent Fox News report confirmed the authenticity of the billboards, with Mission stating that they were “no longer in use due to any unintended misunderstanding.”

Who Is Coming And Why?

The exact numbers are unknown. A 2022 Senate report by former Ohio Senator Rob Portman found the State Department “does not comprehensively track birth tourism,” though tourists largely originate in Mexico, China, Russia, Ukraine, Nigeria, and elsewhere in Asia and South America. Companies like Ada International and Miami Mama once charged five figures for VIP services.

The Cost of Birth Tourism

While birth tourism isn’t strictly illegal, Abbott has instructed the Texas Health and Human Services Commission to investigate “any violations of state law and contractual obligations” and impose sanctions on Mission Regional.

The Center for Immigration Studies (CIS) warns that travelers easily “misrepresent the purpose of their trip to avoid scrutiny,” allowing many to receive “taxpayer-funded public assistance to cover the associated costs of their births” with expenses sometimes waived by the hospital altogether. Economically, that cost is passed along to taxpayers. The Portman report notes “significant adjustments many birth tourists had deducted from their total medical bills and covered by the state health care system or Medicaid,” with some tourists receiving up to $25,000 in adjustments.

The abuse allegations run deeper than one hospital’s ad budget. The 340B Drug Pricing Program is a federal program that gives qualifying hospitals steep discounts on outpatient prescription drugs in exchange for serving low-income patients who don’t qualify for Medicare or Medicaid. 340B sits at the center of the birth toursim story. Mission Regional operates as a member of the Prime Healthcare Foundation, a 501(c)(3) public charity, and its tax-exempt status and financial assistance policy are premised on serving the community’s neediest patients, not marketing deliveries to foreign nationals — even as patients still turn to outside groups for medical debt help. Public records confirm the hospital’s disproportionate-share hospital status and its 340B registration with HRSA since 2016. Watchdogs argue that recruiting paying foreign clients is fundamentally at odds with that mission and is abusing a program built for vulnerable Americans to bankroll billboards in Reynosa.

The program has faced mounting scrutiny for abuse. Republicans in Congress have pushed a crackdown on 340B misuse, and watchdogs like Citizens Against Government Waste warn hospitals nationwide exploit the program at the expense of the vulnerable patients it’s meant to serve. The House Ways and Means Committee has advanced 340B reform legislation recently, and the program was separately tied to a $58 million fraud scheme in which a Haitian national was sentenced to nearly a decade in prison for exploiting a 340B-registered clinic with fake patients and fraudulent prescriptions.

Save Our States put it bluntly: “A Texas nonprofit hospital was just caught advertising ‘birth packages’ for discounted labor and delivery services in Mexico, using taxpayer dollars to facilitate birth tourism and sell out the country.” Public Policy Solutions was blunter still: “You can’t make this up: A taxpayer-subsidized 340B hospital put up billboards near the border advertising childbirth packages to illegal immigrants. Americans are footing the bill for this insanity. 340B was created for vulnerable American patients, not billboards inviting illegal immigrants to give birth in Texas. Oversight is long overdue.”

“Americans are getting blatantly ripped off, and it’s happening right in front of our faces,” Flores argues. “They save the ‘special low rates’ for marketing campaigns abroad while the people who actually live, work, and pay taxes in this country are crushed under inflated, chaotic, predatory insurance-based pricing.”

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