Dozens of patients file through Sutter Solano Medical Center's emergency room every day in this recession-wracked Northern California city, often without insurance, cash or legal immigration status. They all get health care, no questions asked.

Medical providers in Vallejo teamed up to establish the program, generating community opposition because illegal immigrants were among those who benefited from services funded in part with county money. This led to a civil grand jury investigation, and a Board of Supervisors vote.

The partnership survived, but the skirmish was a reminder of how touchy the issue of health care for illegal immigrants remains for many Americans, whether in towns like Vallejo or in Washington, D.C., where legislators are skirting the matter as they work to overhaul the nation's health system.

The program also serves as an example of how a community has found a way to confront the reality that undocumented immigrants will not be covered by health care reforms.

Illegal immigrants make up about one-third of the approximately 24 million people under age 65 who would remain uninsured even under the health reform bills being debated in Congress. With limited exceptions, they do not qualify for federal health programs, and the bills being debated would not change that.

The program in Vallejo, a city of 120,000 northeast of San Francisco, was born from the need to alleviate pressure on overcrowded emergency rooms _ and balance hospital budgets.

Vallejo was hit hard by the foreclosure crisis, filing for bankruptcy in May 2008. Rising unemployment deprived many residents of job-based health insurance.

The number of people showing up at Sutter Solano's emergency room was going up year after year, along with the percentage of those not facing true emergencies. Like other hospitals, it is legally bound to help anyone who shows up, regardless of ability to pay.

The economic downturn made it worse. Over the last two years, the percentage of non-emergency patients in Sutter Solano's emergency department went up 51 percent. Caring for uninsured, non-emergency patients has cost the hospital $1.8 million this year.

Under the partnership, true emergencies are seen at the hospital. Other patients are sent to a clinic where they get long-term care and follow-up visits, all on a sliding fee scale.

Providers say the partnership is saving money, largely because it's better for the hospital to have people get preventive care at the clinic than constantly showing up at the emergency room. Patients say it works.