While the political fight over illegal immigration polarizes the community, professionals such as doctors and teachers who interact with undocumented families daily accept them without question.

Schools, hospitals and other government services generally don't inquire about a person's citizenship status before issuing a locker or setting a broken leg.

"We don't ask. We treat people," said Wes Thompson, IHC vice president for community health partnerships. "We're not the INS. We don't want to be in that role."

Asking too many questions, he said, scares away patients who need medical attention. "We feel like it's a human right to get them health care," Thompson said.

Schools have the same attitude.

"We want to be seen as the nonthreatening people who educate children," said Greg Hudnall, Provo School District student services director.

Providing illegal immigrants access to public education, health care and other social services costs Utah money. There's no question about that. The question is: How much?

An accurate assessment of their perceived drain is elusive.

Those entities generally do not keep track of citizenship status. They say they don't know how many undocumented people they serve. Any attempt to attach a dollar figure to the undocumented immigrants they teach, patch up or provide family support would merely be a guess, something officials in those areas were not willing to do.

National organizations with a particular slant on immigration issues, however, have made attempts to quantify the impact. The results are met with fervor or skepticism, depending on one's point of view.

The federal government, in recent studies on health care and education, took dozens of pages to conclude it doesn't really know the costs.

Gov. Jon M. Huntsman Jr. notes there is "enormous variability" in the reports that do exist. Little is specific to Utah.

Yet, taking education as an example, Huntsman said, "We talk about it like it's breaking the bank."

Utahns don't have a problem with undocumented children getting a free education.

Nearly two-thirds strongly or somewhat favor allowing them to attend public schools, according to a Deseret Morning News/KSL-TV poll. Nearly 75 percent are OK with impoverished illegal immigrants receiving free school breakfast and lunch. And another 60 percent say students who attend at least three years and graduate from a Utah high school should be allowed to pay in-state tuition at the state's colleges and universities.

The Federation for American Immigration Reform says though massive budget deficits in U.S. schools can't be attributed to one source, the "enormous impact of large-scale illegal immigration cannot be ignored."

FAIR, based in Washington, D.C., attempted to quantify the costs of educating undocumented students in the nation's public schools.

For Utah, the group estimated $76.8 million in 2004. It used government estimates of the illegal immigrant population and the state's 1999-2000 per-pupil expenditure reported to the U.S. Department of Education, which was $4,378.

Dividing FAIR's numbers into each other makes 17,542 illegal immigrant schoolchildren in Utah.

The Utah State Office of Education could neither support nor refute the findings.

"I don't know how we could even guess at the those numbers," state school attorney Carol Lear said.

Utah school districts don't have solid data on which to rely, nor are they interested in compiling any.

"We don't know anything about undocumented families," Granite School District spokesman Randy Ripplinger said. "We know zero. . . . We just teach them."

Hudnall couldn't put a dollar amount on it in the Provo District, "but it's a lot of money and a lot of effort."

Though federal law prohibits schools from asking about citizenship, the district's social workers and teachers sometimes know who is undocumented. The goal is to keep them in school and to help them become successful, he said.

Marcella Martinez works as Ogden School District's community liaison. She often meets families who are in the United States illegally. They come to her attention by word of mouth.

Her job is to enroll children in school. She gets them immunized and takes care of paperwork. Children who live with someone other than a parent must have a legal guardian before getting into school. Martinez guides them through the court process.

Establishing trust is usually her first step. People, Martinez says, are cooperative "once they know I'm not working for Immigration."

Ogden School District is 42 percent Hispanic, but administrators do not know how many students are undocumented.

Reed Spencer, Ogden School District executive director for curriculum, estimates teaching illegal immigrants "costs the schools much more in terms of resources," maybe 5 percent to 6 percent of its budget.

Migrant students come with a host of risk factors that makes it difficult for them to learn and for teachers to educate them. Poverty, health concerns and the language barrier hinder learning. Being in the United States illegally adds to the stress, he says.

Parents don't become involved in their children's education partly because they aren't fluent in English and likely do not trust government-run schools.

"They believe one government agency is just like another," Spencer said.

One Ogden elementary school invited migrant workers to a parents' meeting. The turnout was sparse.

"They were afraid to come because they thought they were all going to get huddled together and shipped out," said Rich Moore, Ogden School District coordinator.

The former U.S. Immigration and Naturalization Service has conducted two notable raids in Utah the past few years. One at the Salt Lake City International Airport just prior to the 2002 Olympics and another at Champion Safe Co. in Provo the following year.

Both left spouses and children of breadwinners needing intervention from several state agencies, including the Division of Child and Family Services.

"But those are so few and far between," said Duane Betournay, DCFS deputy director for regional offices.

Like other state agencies, DCFS doesn't consider citizenship when it assists families. It only comes into play when immigration officials are involved, and those situations are rare, he says.

DCFS deals with a smattering of abused and neglected children of illegal immigrants, Betournay says. He believes those cases go underreported as do others like domestic violence and physical and mental health concerns.

A study published in the American Journal of Public Health last month refutes the assumption that immigrants, regardless of legal status, are a disproportionate burden on the U.S. health-care system.

Researchers found immigrants received an average of $1,139 worth of care, compared to $2,564 for nonimmigrants. The gap was wider among children, who received one-fourth the care given to U.S.-born youngsters.

The report is based on health-care spending data for 21,000 people that the government tabulated in 1998, the most recent year for which numbers were available. It included documented and undocumented immigrants.

Children are most at risk of not receiving health care. The study showed immigrant children had fewer doctor visits, took less medication and made fewer emergency-room visits. Their emergency-room costs, however, were triple those of American-born children, suggesting families waited until a condition was serious before getting treatment.

Federal law mandates hospitals treat anyone who needs emergency medical care, including undocumented immigrants, regardless of their ability to pay. Hospitals have policies against asking about patients' citizenship status.

Utahns agree that they should get care, at least when it comes to emergencies.

A Deseret Morning News/KSL-TV poll showed 79 percent of residents think undocumented immigrants should receive emergency hospital treatment whether or not they have insurance or have the ability to pay.

Still, 17 percent think emergency rooms should not see them.

How the care should be paid for split respondents several ways, according to the Dan Jones & Associates survey of 413 Wasatch Front residents.

The federal government, charities and others (primarily a combination of public and private sources) each came out at 26 percent. Another 11 percent say state and local government should cover the costs, while 6 percent leave it to hospitals.

In some parts of the country, treating illegal immigrants has taken a toll on already strapped hospital budgets.

A 2002 study by the United States-Mexico Border Counties Coalition found that emergency care saddled hospitals in California, Arizona, New Mexico and Texas with $200 million in unpaid bills.

The state Division of Health Care Financing was one of the few Utah government agencies that could calculate medical costs for illegal immigrants.

Last year, 4,146 people received emergency Medicaid, totaling $18.5 million or about $4,464 per person, according to a report generated for the Deseret Morning News. Emergencies include care for any condition reasonably expected to result in death or permanent disability, and labor and delivery.

By way of the comparison, the Utah State Prison health-care budget was $19.5 million last year. It covers medical, mental health, drugs, optometry and dental. The cost per inmate is about $3,150.

Because hospitals don't track immigration status, the total financial impact is hard to pinpoint. Uncompensated care costs for illegal immigrants nationwide remain uncertain, according to a 2004 General Accounting Office study.

That holds true in Utah.

Neither Intermountain Health Care nor University Hospital could quantify how much of their uncompensated care went to that population. Gordon Crabtree, University Hospital chief financial officer, estimated it as a "very minor part of" the overall charity care or bad debt.

Based on observation, however, administrators say the number of undocumented patients is growing.

"I can tell you anecdotally it is getting worse," Utah Hospital Association President Joe Krella said.

Hospitals will continue to provide charity care for undocumented patients because that is what they do.

"The frustration is that this is a federal issue and we don't have a consistent federal policy for dealing with it," Krella said.

The federal government this year through 2008 will provide $250 million a year to reimburse hospitals, certain doctors and ambulance services for emergency care for illegal immigrants.

Based on 2000 Census estimates of the undocumented population, Utah may access up to $1.5 million.

"That money isn't near enough to cover the extent of the problem," Krella said.

Applying for the money also presents hospitals with a bit of a Catch-22. Although they aren't supposed to inquire about a person's immigration status, they must identify the patient as an undocumented immigrant to be eligible for the reimbursement. In addition, Krella says the application process is cumbersome.

"The bottom line is, these immigrants are getting care, but it's just one more strain on the system and how much more can it take?" he said.

The four hospitals IASIS Healthcare owns in Utah began seeking citizenship information from patients in June to apply for the federal reimbursement, spokesman Doug Boudreaux said.

Many undocumented people wait until an ailment turns acute before seeking medical attention, and when they do, it is typically at a hospital emergency room. Some lack health insurance or the means to pay. Others fear revealing personal information that could lead to being deported.

In Mexico, hospitals are the center of the health-care system. It is the place to go for everything from a sore throat to a heart attack. Not so in the United States.

"In a lot of ways, it's a cultural thing," said Bette Vierra, executive director of the Association of Utah Community Health. "It's not just because they're afraid to go someplace else."


Coming Saturday: Solutions

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