The Congressional Budget Office has underestimated Medicaid spending by billions of dollars every year for some time now and a new law that reduced illegal immigration in Florida may explain why.

Since 2000, the CBO has underestimated an average of $15 billion a year of Medicaid spending, while often overestimating Social Security and Medicare spending. The latest CBO budget outlook bumped up Medicaid spending estimates yet again, this time by another $50 billion over the next 10 years. But judging by its recent performance, the new projections will still be too low.

Something in the Medicaid program is adding tens of billions to the deficit every year. Thanks to a recent law passed by Gov. Ron DeSantis (R-FL) in Florida, we may now know what it is. It is probably President Joe Biden’s border crisis.

Becoming law on July 1, 2023, Florida’s Senate Bill 1718 mandated the use of E-Verify, banned local governments from issuing identification cards to illegal immigrants, and ordered all hospitals to ask patients for their legal status. The bill did not ban hospitals from caring for illegal immigrants, which would contradict federal law, but did require them to collect the information.

Open border activists howled, predicting that most illegal immigrants would flee the state, crippling Florida’s economy. It does indeed appear that many illegal immigrants have left Florida. “Obviously there has been somewhat of an exodus of migrants from Florida,” Thomas Kennedy of the Florida Immigrant Coalition said. But the economic Armageddon scaremongers predicted did not happen. Florida’s economy is growing faster than the national average, its unemployment is lower, and wages keep rising.

In addition to avoiding predicted economic calamity, the state has saved money on providing uncompensated medical care because illegal immigrants have left the state. The effect has been dramatic. Although illegal immigrants are not eligible to be enrolled in Medicaid, all hospitals must provide emergency healthcare under federal law to whoever needs it. The federal government picks up most but not all of the tab.

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In the last full fiscal year before SB 1718, Florida made 146,883 emergency medical assistance approvals, spending $171.4 million. Federal taxpayers picked up $99.4 million and Florida taxpayers picked up the remaining $72 million. This year Florida has made far fewer emergency referrals and is on pace to spend just $100 million on emergency Medicaid care, a 40% reduction. This will save U.S. taxpayers $41.1 million and Florida taxpayers another $30 million. When one considers that these are the numbers dealing only with Florida, it is easy to see, even though an exact number is unknowable, that mass illegal immigration is costing Medicaid an enormous sum nationally.

Uncompensated emergency Medicaid spending is just one cost of Biden’s hapless or cynical refusal to enforce the law and make the national border secure. Most of the fiscal burden falls on states in the form of housing, food, and education. Costs are also so dispersed that we will probably never know the true price. But voters across the country are feeling the fiscal pain, and they want a new direction.