Part one of a three-part series: COURTHOUSE — In the past decade, the number of illegal immigrants has continued to rise in Montgomery County — particularly in Norristown, which has the highest number of Mexican nationals — and the newcomers continue to test the limits of medical services, public schools and law enforcement, according to local officials.

Despite criticism, many have positive things to say about immigrant-owned restaurants and retail stores that have sprung up to brighten Norristown’s urban landscape.

But with Pennsylvania and its counties facing budget deficits, many wonder how long government can continue to subsidize the burgeoning low-income population that is straining vital services. Currently, state legislators are considering a more restrictive law mirroring Arizona’s to stem the tide of the undocumented settling in the state.

In an award-winning Times Herald series on illegal immigration by Joseph Gidjunis in 2003, the number of immigrants then living in the Norristown area, the great majority natives of Mexico, was estimated at 12,000, by Miguel Dones of Conecciones. Current estimates range between 10,000 and 20,000, depending on the source.

Acción Comunal Latinoamericana de Montgomery County (ACLAMO), a social services agency operating in Norristown since 1976, estimates between 15,000 and 20,000 Latinos reside in Norristown and Bridgeport combined.

“We don’t know exactly how many there are,” said Juan Guerra, ACLAMO’s executive director.

While numbers are hard to pin down, he conceded that most Hispanics in the local area are violating U.S. immigration law.

“The majority are undocumented,” he said.

Using 2008 U.S. Census Bureau figures, Federation for American Immigration Reform (FAIR), a Washington-based nonprofit public policy group that opposes illegal immigration, estimates the foreign-born population in Montgomery County to be about 68,625, or 8.8 percent of the total county population of at least 778,000. Census figures a year later bumped the total to 782,339.

In 2008, Census reported those of Hispanic or Latino origin in the county numbered around 25,817, or 3.3 percent of the total population. According to 2000 figures, there were only about 3,200 Hispanics living in Norristown, or about 10.5 percent of the town’s population at that time.

Though accurate counts remain elusive, most local officials believe the numbers of Latinos have continued to grow since the 2003 newspaper series.

Guerra said Norristown’s Gotwals Elementary School’s student body is currently about 60 percent Hispanic.

“There’s virtually a tsunami of schoolchildren coming into the (Norristown) school system,” he said.

The statewide influx of immigrants over the past few years is costing taxpayers millions, according to “The Costs of Illegal Immigration to Pennsylvanians,” a 2009 report published by FAIR.

According to FAIR, the illegal alien population in the state has nearly tripled since 2000, and currently foreign-born individuals cost state taxpayers about $728 million for education, medical care and incarceration.

So far, however, county officials have been unable or unwilling to estimate how much it costs taxpayers to subsidize illegal immigrants in Norristown and are reluctant to talk on the record about the issue.

In 2003, many local Hispanic residents went to the Regional Health Center on Main Street in Norristown for basic medical visits. But in an emergency, then and now, they depend on Montgomery Hospital Medical Center (MHMC) for treatment. Under federal law, hospitals must treat medical emergencies regardless of a person’s ability to pay.

The hospital has seen birthrates rise and fall in the past decade, and the majority of birth mothers are believed to be illegal immigrants, according to county officials. Since 2007, childbirths have increased each year and are expected to skyrocket in 2010.

In 2003, a total of 735 babies were delivered at the Norristown hospital; 636 in 2004; 655 in 2005; 624 in 2006; 632 in 2007; 691 in 2008; 823 in 2009; and deliveries this year are expected to reach at least 1,000, according to hospital projections. Hospital officials do not collect data on birth mothers’ legal status, so it is not known what portion of these births were to women here illegally.

And with the recent closing of nearby Mercy Suburban Hospital, a Montgomery County Health Department official predicted in May that births could climb as high as 1,500 by year’s end at MHMC.

For the past two years, expectant women inadequately covered or uninsured have outnumbered privately insured mothers.

This trend is driving uncompensated care steadily higher at hospitals across the Philadelphia region, according to Priscilla Koutsouradis, communications director for Delaware Valley Healthcare Council.

Charity care and bad debt account for the mounting financial losses, she said, and no single group — including Hispanics — is responsible for the increase in unpaid care. Even if illegal alien women were to blame, Koutsouradis said hospitals wouldn’t know, because the staff does not inquire about a patient’s immigration status.

The impact of Medical Assistance, Pennsylvania’s Medicaid insurance for low-income people, is a significant factor in the escalating medical costs.

“Medical Assistance underpayment is a huge one,” she said. “Now, Medical Assistance pays less than 80 cents (on the dollar) for inpatient and outpatient care.”

Because those reimbursements don’t cover the full cost of care, they add to a medical facility’s debt.

In 2010, of the 1,000 anticipated births at Montgomery Hospital, about 400 are expected to have adequate coverage, according to hospital spokesperson Laura McFarland. Given that the Norristown medical center loses an average of $2,500 for each baby born, this could mean a $2.5 million loss this year. If deliveries spike to 1,500, the financial loss would climb to $3.75 million.

Once a woman here illegally gives birth, her child is considered a U.S. citizen and eligible for government benefits.

Over the past decade, uncompensated care at MHMC has risen from $3.7 million in 2001 to a projected $16.2 million this year, according to hospital data.

Mercy Suburban Hospital, which stopped providing obstetrics services Feb. 28, was the seventh Pennsylvania hospital to stop delivering babies in the past five years. A “combination of decreasing volume, ongoing cuts in reimbursement and increasing costs resulted in growing losses that are no longer sustainable,” according to a hospital statement. A health official hinted this week that the large number of low-income Latino women giving birth in recent years hastened the obstetrics program’s demise.

And the Obama administration’s recently-passed health care overhaul legislation is expected to make the fiscal crisis worse, Koutsouradis said.

“It will increase the number of people eligible for Medical Assistance,” she said, potentially adding 12 to 16 million or more new Medicaid enrollees in cash-strapped Pennsylvania.

As in 2003 when Gidjunis’ articles were published, employment is the incentive that still attracts many to the Norristown area from Mexico.

“If the economy continues to dip, then they go where there’s work,” Guerra said.

After a May meeting, county Commissioner Jim Matthews pointed out Mexicans are drawn to Norristown because the county, and Philadelphia County, offers free prenatal care for pregnant women regardless of their legal status.

“What angers me is that so many non-Americans, undocumented people, are coming here. And I’m confident that just as they know when they cross that border down there, they know there’s mushroom work in Chester (County), they know there’s landscaping work in Schuylkill County, they know there’s (work) up here in Montgomery County, it’s our No. 2 industry,” he said.

Minutes earlier, he, and fellow commissioners Joseph M. Hoeffel and Bruce L. Castor Jr. voted to authorize the county Health Department to tap state funding for the prenatal care. Afterward, Matthews was asked to defend his support given his misgivings about attracting illegal aliens here.

“I don’t want to vote for what could be crippling a program that could be avoiding millions of dollars in post-natal (specialty) care for an infant,” he said, which could result from complications during childbirth due to a lack of prenatal care.

When the series ran in 2003, supporters of amnesty for undocumented workers in the U.S. stated that Mexican workers were doing work Americans refused to do. But an anecdote Matthews related undercut that conventional wisdom and illustrated his ambivalence about approving the funds.

The commissioner regularly eats at Ray’s Diner on Germantown Pike. One day while there, he noticed the car wash next door was closed. He learned the business had been raided by authorities, and the employees there, all Mexicans here illegally, were forced out of jobs.

“Then I saw something I hadn’t seen in six or seven years – young black kids working at the car wash,” he said. “Never, ever was there an African-American kid working at that car wash. After the car wash shake-up, the owner hired local teenagers, as he should have done in the first place, Matthews said. “That’s the indignation I have.”

Currently, the federal government only arrests those in the country illegally if they’re suspected of commiting a felony. Often those convicted are deported only to return to the U.S.

And compared to 2003, the American public’s opposition to amnesty for illegal aliens appears to have intensified in recent years as have calls for the federal government to seal the border separating U.S. and Mexico.

Part two, Living in the shadows, will appear July 11.