Hundreds of Mexican immigrants and their families are at this health fair at the Mexican consulate in Sacramento. They're stopping at information booths, getting basic dental exams, and lung screenings.
Dr. Sunil Perera is donating his time to screen people for possible lung problems. He's holding what looks like an oversized remote control. He enters data, and hands the device over to anyone willing to try it.
PERERA: "Now, Jose Medina... [you] smoked in the past. Jose, do you still smoke?"
MEDINA: "Cuando era joven, si."
TRANSLATOR: "When he was young…"
Jose Medina says he came to the health fair today because he heard on TV he could get a flu shot. He says construction work has been hard to find lately, and he only gets health services that are free. Dr. Perera says Jose's lung test doesn't look good.
"His lung age is 89, and he's only 40," says Perera. "So the effect of his smoking, plus air pollution where he works, all that affects his lung. He doesn't know, he continues, someday he can't breathe, he'll end up in the emergency room, can't breathe. That drives the cost of health care."
The health fair is part of a Mexican government-funded program called Ventanilla de Salud, or "health window." It contracts with local non-profits who help raise money for the program. It operates within the Mexican consulate, because that's where hundreds of Mexican immigrants go every day to take care of official business.
The Ventanilla program is set up right next to a large waiting room. The office is covered with health posters and handouts.
Isabel Flores is there to answer their questions. She says a lot of the immigrants here are used to going to the emergency room, or not going to the doctor at all.
"They end up in the emergency room because they don't know where to go," says Flores.
"Once they're there and they see how long it takes, or that bill and comes later and how large it is, that is an easy way for them to get discouraged. They'll say 'oh, well, I went to get services, but then this is what happened, and I don't want to go back.'"
Flores says they're going to the ER for conditions like diabetes or high blood pressure.
"They come in and say 'oh yeah, can you please let me know what hospitals I can go [to]? And I say 'No no no, it's not hospital, it's clinic. And I explain to them the difference. And this way they know what the difference is, they know that a hospital or an emergency room should be for an emergency," explains Flores.
So Isabel hands out a list of local clinics. Some of them are run by churches or medical student volunteers, others are clinics that receive federal money.
That idea concerns people like Ira Mehlman of Federation for American Immigration Reform or FAIR. FAIR says the federal government spends almost 6 billion dollars a year on medical care for undocumented immigrant families.
"The US needs to make it very clear that we cannot afford to pay for health care for people from all over the world," says Mehlman. "What we need to do is to establish immigration laws, and enforce immigration laws in a way that discourages people from coming here in the first place."
But a RAND study suggests the amount of government money spent on undocumented immigrants is much lower than the FAIR estimate, and overall, accounts for just a small fraction of government spending on health care. It says the undocumented consume less health care, and may be healthier than the larger American population.
The Ventanilla program is one of 50 at Mexican Consulates around the United States. Consul General in Sacramento Carlos Gonzalez Guitierrez says the Ventanilla programs help people find care who may be too afraid to seek it out otherwise.
"To the extent that people with chronic diseases constitute a public health risk if they not treated, to the extent that emergency rooms are extremely expensive, I think that the Ventanilla de Salud programs provide an important service to society as a whole," says Gonzalez-Guitierrez.
The Ventanilla program also helps Mexicans sign up for their country's public health insurance. If they choose to go back, care is low-cost, or free.
The California Endowment provided initial funding for the Ventanilla de Salud program. The Endowment also provides financial support to Capital Public Radio.