Pushing around a cart filled with steamed corn, sliced cucumbers and other street food, Omar Castillo is the embodiment of what has become a third rail in the healthcare debate.
The 19-year-old, who received a kidney transplant last year, is in the U.S. illegally and has no ready access to long-term medical care. So peddling snacks is how he pays for the expensive drugs he needs to stay healthy.
To cover the needs of an estimated 6.8 million uninsured illegal immigrants, some advocates have proposed broadening the healthcare overhaul legislation now before Congress.
But fierce opposition has kept the idea off the table.
Castillo received his transplant and a year of free medicine as part of a hospital study at the University of Illinois Medical Center at Chicago after lobbying by Latino activists and a call from the governor's office. With the study over, his last free prescription is running out.
"We don't know what we'll do when the medicine is gone," said Castillo, holding two nearly empty bottles of the immunosuppressants he takes to ward off an organ rejection.
It is immoral, immigration activists say, for hospitals and doctors -- as well as a nation -- to deny healthcare to the seriously ill, no matter their legal status. But proponents of tougher immigration enforcement and others fighting to contain runaway costs fear that providing such services would encourage more illegal border crossings.
Given spotty healthcare in countries such as China and Mexico, "health insurance alone might be worth people coming here . . . especially if you've got a family that's got a lot of illness in it," said Roy Beck of NumbersUSA, which has pushed for tighter restrictions on medical aid to illegal immigrants.
The issue is so sensitive that House Speaker Nancy Pelosi (D-San Francisco) has made a point of emphasizing that illegal immigrants would not be covered under the current healthcare proposals. And the Congressional Hispanic Caucus issued a statement backing coverage only for "legal, law abiding" immigrants who pay their "fair share" for healthcare.
Under federal law, illegal immigrants are entitled to receive emergency healthcare, although some states offer assistance to cover uninsured children.
For some, a struggle
Some illegal immigrants have used stolen Social Security numbers to qualify for health programs -- a form of medical identity theft increasingly on hospital radars. Many more scramble to pay for their medicine and doctors visits in cash, a challenge in an economy where day-laborer work has dried up.
"A lot of people are living with things that are easily treatable [and] that those of us with good health insurance just don't have to live with because we can go get the medication," said Jennifer Tolbert, a policy analyst at the nonprofit Kaiser Family Foundation.
"If those individuals have communicable diseases," Tolbert said, "there may be a risk [of] spreading that condition."
Castillo's prescriptions for mycophenolate mofetil and tacrolimus can cost as much as $750 a month.
After about six hours of selling snacks in the hot sun on a recent day, he and a cousin took home $20, money that also must go toward food and other needs.
Castillo arrived from Mexico City in 2005.
He worked in construction for about six months, but he began growing weak and had trouble breathing, family members said.
A doctor discovered Castillo was born with a partly developed kidney.
Compared with others who are uninsured and facing chronic illness, Castillo has been lucky.
Last summer, the medical center assumed the cost of his kidney transplant after a group of activists rallied outside the hospital and persuaded then-Gov. Rod R. Blagojevich to make an appeal on Castillo's behalf.
Concerns over the financial burden -- an organ transplant can cost upward of $150,000, not counting follow-up care -- have led other hospitals to deny treatment, said Julie Contreras, an organizer with the League of United Latin American Citizens in Chicago.
"These people, some of them are going to die," Contreras said. "When a hospital denies treatment to any human being . . . this is flat-out immoral."
In Chicago, about a dozen immigrants in need of organ transplants have formed an informal support group.
They sat recently inside one patient's home, comparing kidney dialysis regimens and worries over mounting hospital bills. Within the group, sharing medicine is common.
In cases where pills are running out, so is rationing: one pill a day instead of three.
Asked about returning to Mexico or other home countries to receive more comprehensive care, the group broke into laughter.
"Over there, it's a thousand times worse," said Juan Zavala, a legal immigrant from Mexico and a transplant recipient. "Here, you may get treated poorly by some nurse or doctor. There? They'll give you a kick and tell you you're out of luck."
Sitting nearby was 16-year-old Liliana Cruz. After she was diagnosed with kidney failure, her family came to the U.S. illegally from Mexico in 2005 to seek help in getting a transplant.
But the operation is still beyond their reach. Cruz's age qualifies her to receive a transplant paid for by Illinois' All Kids health subsidy program, and she has a willing donor in an adult sister. But the University of Illinois Medical Center has declined the procedure because the sister's part of the surgery would not be subsidized.
"I just want a normal life," Cruz said during a recent round of kidney dialysis paid for by the state. "Right now, this machine is my life."