OAKLAND, Calif. — Perched at the edge of an exam table, Delmira Maravilla is anxious for a check-up — and for a timeline on the president's promise of health care for all Americans.
She's paying out of pocket for the exam, and like one-third of Hispanics, the mother of nine doesn't have health insurance.
Latinos like this immigrant from El Salvador have much to gain if the legislation taking shape in Washington passes. Among the major ethnic groups, they are the least likely to have health coverage through work. And Hispanics often face language and cultural hurdles to getting good-quality health services. They're far less likely to have a regular health-care provider, and to get the kind of routine screening that prevents serious health problems.
Maravilla knows how easily her family's carefully calculated budget can be overwhelmed by the cost of health care: her 6-year-old daughter's recent fall against the edge of a table set her back a devastating $1,500 in emergency room bills. Any accident, any unexpected illness, can be catastrophic, she said.
"I would be so much calmer, less worried, if I knew I had health insurance for my family," she said. "Health problems happen to everyone, but it's too expensive for us who are poor."
Experts say health disparities among ethnic groups are great, with one in three Hispanics and one in five African-Americans not having health insurance, compared with one in eight whites. And as the recession deepens, the gap is growing along with rising unemployment and cuts to work-sponsored insurance.
"We can't have the status quo. It's just a disgrace. I don't know what other words to use," said Elena Rios, president of the National Hispanic Medical Association, a nonprofit group that represents Hispanic doctors.
Rios was among the advocates calling on legislators to consider measures designed to bolster care for Hispanics through preventive medicine, health education and increased diversity in the medical field.
Jane Garcia, the CEO of La Clinica de la Raza where Maravilla gets her checkups, sees the need for reform every time she makes her rounds.
About 71 percent of her patients are Latino; 44 percent are uninsured, and that number has been going up. New patients range from the recently unemployed to undocumented immigrants who can no longer get care in neighboring Contra Costa County, where supervisors squeezed by a budget shortfall voted to cut services to them.
"The number of people presenting for services are really overwhelming to the system," she said. "And more of them are coming in uninsured."
Although the House bill represents the most comprehensive effort to date to extend health care to all Americans, there is a significant segment of the population that will likely be excluded: illegal immigrants. Pressed by CBS News' Katie Couric about whether they should be covered, the president responded simply, "no."
Absent immigration reform and a path to citizenship, that would mean millions could be left out of the system. About 59 percent of the 11.9 million undocumented immigrants living in the United States have no health insurance, according to the Pew Hispanic Center.
Advocates are split on whether to hold out for reform that includes them, or support change that would help the majority of Hispanics.
"This has always been in the elephant in the room — all of our families are mixed, some documented, some undocumented," said Rios. "But we're so close to having health care reform. We'd be working against ourselves to let immigration issues stall the process."
Others, like Jennifer Ng'andu, deputy director of the National Council of La Raza's Health Policy Project, believe any plan that doesn't include undocumented immigrants won't last. They make up about 15 percent of the nation's approximately 47 million uninsured.
"If we don't talk about integrating communities that have been traditionally shut out, we're going to be talking about health care reform again in 15 years," said Ng'andu, who has been talking to legislators and to health care advocates on their behalf.
To proponents of greater immigration controls, allowing illegal immigrants to benefit from federally subsidized health care and insurance would go against enforcement goals by legitimizing their presence.
"They would have no incentives to leave," said Mark Krikorian, of the Center for Immigration Studies.
Undocumented immigrants are the majority of Rogelio Fernandez's patients at the United Health Centers clinic in Parlier, a town of approximately 12,000 whose population swells and dips with field workers following agriculture's planting, pruning and harvest seasons.
His clinic provides primary care on a sliding-fee scale and discounted medication to those who need it. But in this tough economy, he's seeing patients cut back on visits and on their medication because, without insurance, they can't afford them.
"Unless they are more inclusive, these proposals really won't help a lot of our patients," said Fernandez.
Studies show that inadequate access to regular, quality health care that meets their language needs has consequences. Hispanics are suffering disproportionately from chronic diseases such as diabetes and getting less preventive measures such as cancer screenings and obesity counseling.
Not taking care of this population now will have real costs in the future, said Rios. Hispanics make up 15 percent of the total U.S. population, but they represent 25 percent of children in preschools and kindergartens.
"We are at a time when we need change, or we're going to see an increase in obesity, diabetes, cancers, heart disease," said Rios. "It's not fair to them, to us, to the country."