Wall Street Week Ahead: Holiday "on standby" as clock ticks on cliff

NEW YORK (Reuters) - The last two weeks of December are traditionally quiet for stocks, but traders accustomed to a bit of time off are staying close to their mobile devices, thanks to the "fiscal cliff."

Last-minute negotiations in Washington on the so-called fiscal cliff - nearly $600 billion of tax increases and spending cuts set to take effect in January that could cause a sharp slowdown in growth or even a recession - are keeping some traders and analysts from taking Christmas holidays because any deal could have a big impact on markets.

"A lot of firms are saying to their trading desks, 'You can take days off for Christmas, but you are on standby to come in if anything happens.' This is certainly different from previous years, especially around this time of the year when things are supposed to be slowing down," said J.J. Kinahan, chief derivatives strategist at TD Ameritrade in Chicago.

"Next week is going to be a Capitol Hill-driven market."

With talks between President Barack Obama and House Speaker John Boehner at an apparent standstill, it was increasingly likely that Washington will not come up with a deal before January 1.

Gordon Charlop, managing director at Rosenblatt Securities in New York, will also be on standby for the holiday season.

"It's a 'Look guys, let's just rotate and be sensible" type of situation going on," Charlop said.

"We are hopeful there is some resolution down there, but it seems to me they continue to walk that political tightrope... rather than coming up with something."

Despite concerns that the deadline will pass without a deal, the S&P 500 has held its ground with a 12.4 percent gain for the year. For this week, though, the S&P 500 fell 0.3 percent.

BEWARE OF THE WITCH

This coming Friday will mark the last so-called "quadruple witching" day of the year, when contracts for stock options, single stock futures, stock index options and stock index futures all expire. This could make trading more volatile.

"We could see some heavy selling as there is going to be a lot of re-establishing of positions, reallocation of assets before the year-end," Kinahan said.

RETHINKING APPLE

Higher tax rates on capital gains and dividends are part of the automatic tax increases that will go into effect next year, if Congress and the White House don't come up with a solution to avert the fiscal cliff. That possibility could give investors an incentive to unload certain stocks in some tax-related selling by December 31.

Some market participants said tax-related selling may be behind the weaker trend in the stock price of market leader Apple . Apple's stock has lost a quarter of its value since it hit a lifetime high of $705.07 on September 21.

On Friday, the stock fell 3.8 percent to $509.79 after the iPhone 5 got a chilly reception at its debut in China and two analysts cut shipment forecasts. But the stock is still up nearly 26 percent for the year.

"If you owned Apple for a long time, you should be thinking about reallocation as there will be changes in taxes and other regulations next year, although we don't really know which rules to play by yet," Kinahan said.

But one indicator of the market's reduced concern about the fiscal cliff compared with a few weeks ago, is the defense sector, which will be hit hard if the spending cuts take effect. The PHLX Defense Sector Index <.dfx> is up nearly 13 percent for the year, and sits just a few points from its 2012 high.

(Reporting by Angela Moon; Additional reporting by Chuck Mikolajczak; Editing by Jan Paschal)

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The Hard Road Back: Chaplain with Traumatic Brain Injuries, Finds Tables Turned

A Counselor in Need:
Sent home from Iraq, Lt. Col. Richard Brunk, an Army chaplain, returned to Houston, where he is learning to cope with a serious brain injury.

It was Lt. Col. Richard Brunk’s second Sunday in Baghdad, and so, of course, there was church. Only 16 soldiers showed up, but that was good for that busy day, election day across Iraq. The presiding chaplain asked everyone to take seats up front. It was a providential move.

A 122-millimeter rocket exploded outside, virtually collapsing the rear of the chapel. Colonel Brunk was pitched forward, an outstretched arm failing to stop his head from hitting the marble floor. Gathering himself amid the chaos, he noticed some foil-wrapped chocolates scattered like pebbles before him and offered one to the chaplain, sprawled on the ground nearby.

“If I’m going to die, it’s going to be with chocolate on my breath,” the colonel said jokingly. The chaplain moved his lips in reply. “And I realized: ‘Uh oh, I’ve got a problem,’ ” Colonel Brunk recalled. “Because I couldn’t hear him.”

The explosion broke Colonel Brunk’s wrist, shattered both his eardrums and rattled his skull, medical records show. It would be the first of two major blasts in 2005 that traumatically injured his brain.

Seven years later, the symptoms have not gone away. Colonel Brunk, who retired from the Army this summer, regained his hearing, but he still has daily headaches, ringing in his ears, double vision and dizziness, all typical of traumatic brain injury, or T.B.I. Occasionally he struggles to remember once-familiar words, faces and names.

The military says it has diagnosed more than 260,000 cases of T.B.I. since 2000, about 42,000 of them involving deployed troops. That is less than 2 percent of the service members sent to Iraq and Afghanistan, and many experts believe that the actual number is higher. Though three in four of those cases were labeled “mild,” many veterans like Colonel Brunk have struggled with powerful aftereffects for years.

In his case, age has been a factor. A chaplain himself, Colonel Brunk was 54 when he was injured, a rarity in these wars, where 99 percent of the 2.3 million troops who deployed to Iraq or Afghanistan were under 50. Now 62, he faces a much steeper path to recovery than a younger person, doctors say.

But emerging research shows that traumatic brain injuries may have long-term effects on troops of all ages. A study by the University of Oklahoma this year, for instance, found that a majority of veterans treated at a traumatic brain injury clinic continued having headaches, dizziness and poor coordination eight years after their injuries.

Data from the Center for the Study of Traumatic Encephalopathy at Boston University suggests that multiple traumatic brain injuries during one’s youth may be linked to degenerative brain disease later in life.

Colonel Brunk’s story underscores another important issue: how poorly the military understood brain injuries early in the wars.

Since 2009, the Pentagon has required troops suspected of having head injuries to rest immediately after blast exposure, a crucial period when brains can often heal themselves, doctors say.

But in 2005, Colonel Brunk was allowed to return to work within hours of his first exposure. When doctors eventually recognized that he had neurological damage, he was sent home for about three months but was treated mainly for hearing problems. He was then permitted to return to Iraq, at his own request, where he had a second, potentially devastating head injury.

He had gone to war not expecting to experience warfare quite so intimately. But once he was hurt, he was determined to rejoin his battalion and finish the tour with his flock. And like many of those soldiers, he did his level best to ignore injury, pain and, eventually, a collapsing marriage.

“I went to Iraq a chaplain,” Colonel Brunk says. “But I came home a soldier.”

But to those close to him, his dogged good cheer was a mask that did not always serve him well. “People look at him and say, ‘That’s Chaplain Brunk, he can’t be having problems,’ ” said Kathy Curry, a close friend. “But he’s got problems at home. He’s got T.B.I. He’s got pain.”

And so, not long after meeting him, Ms. Curry felt compelled to ask: Who counsels you? Who counsels the counselor?

The answer, for a time at least, was nobody.

He had wanted to be a doctor, but college microbiology killed that notion. So he followed his father, an Army chaplain, into the ministry, leading Texas parishes of the Evangelical Lutheran Church while volunteering as chaplain for fire departments and hospitals. But the military, a family tradition, called.

In the fall of 1989, Colonel Brunk found himself chatting with an Army chaplain recruiter at a church convention in New Orleans. By the end of their stroll down Bourbon Street, the minister had signed on for the Texas National Guard. He was 39.

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U.S. gun website sued for alleged ties to slayings

CHICAGO (Reuters) – A prominent U.S. gun control group on Wednesday sued a gun auction website it says is linked to a mass shooting at a Wisconsin spa in October and the stalker slaying of a woman near Chicago in 2011.

The Brady Center to Prevent Gun Violence alleges that the design of armslist.com facilitates illegal online sales to unlawful gun buyers with no background checks, and enables users to evade laws that permit private sellers to sell guns only to residents of their own state.

“We as a nation are better than an anonymous Internet gun market where killers and criminals can easily get guns,” said Jonathan Lowy, the Brady Center’s Legal Action Project Director, in a statement.

The wrongful death lawsuit was filed in Cook County Circuit Court on behalf of the family of Jitka Vesel, 36, an immigrant from the Czech Republic who was shot and killed last year by Demetry Smirnov, a stalker.

The suit, which the Brady Center says is the first of its kind, alleges that Smirnov illegally bought the gun from a private seller he located through armslist.com.

Vesel was killed in the parking lot of the Chicago-area Czechoslovak Heritage Museum, where she was a volunteer preparing for a celebration in memory of Czech-American Chicago Mayor Anton Cermak.

Cermak was slain with a handgun during an attempted assassination of President Franklin D. Roosevelt in 1933.

A representative for website owner Armslist, LLC was not immediately available for comment. The company is based in Noble, Oklahoma, according to public records.

The website includes a “terms of use” page on which users must promise they are age 18 or older and will not use the site for illegal purposes.

The Brady Center said that the case does not infringe on the Second Amendment right to bear arms, noting that 74 percent of National Rifle Association members believe that no guns should be sold without a criminal background check.

A representative for the NRA was not immediately available for comment.

Radcliffe Haughton, who killed his estranged wife and two other women and wounded four others before killing himself in a shooting in a Milwaukee suburb on October 21, also got his weapon through armslist.com, according to Wisconsin officials.

Haughton, who was under a restraining order for domestic violence, avoided a background check through a “lethal loophole” by buying a gun through the website, according to a letter to Armslist sent by Milwaukee Mayor Tom Barrett and Wisconsin U.S. Representative Gwen Moore on October 26.

Sales conducted over the Internet also have been linked to mass killings at Virginia Tech and Northern Illinois University. In 1999 eBay announced it was prohibiting online gun sales, according to the Brady Center lawsuit.

Craigslist did the same in 2007. Amazon.com and Google AdWords also prohibits the listing of firearms for sale, the suit says.

An undercover investigation of online gun sales by New York City last year found that 62 percent of private gun sellers agreed to sell a firearm to a buyer who said he probably could not pass a background check.

(Reporting By Mary Wisniewski; Editing by Greg McCune and Xavier Briand)

Internet News Headlines – Yahoo! News

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Donald Faison Marries Cacee Cobb

By Lesley Messer

12/15/2012 at 08:25 PM EST

Cacee Cobb and Donald Faison

Dr. Billy Ingram/WireImage

It's official!

After six years together, Donald Faison and Cacee Cobb were married Saturday night at the Los Angeles home of his Scrubs costar Zach Braff.

Cobb's friend Jessica Simpson was a bridesmaid. Sister Ashlee Simpson also attended.

"What a happy day," Tweeted groomsman Joshua Radin, a singer, who posted a photo of himself with Faison and Braff in their tuxedos.

The couple got engaged in August 2011. At the time, Faison Tweeted, "If you like it then you better put a Ring on it," and Cobb replied, "If she likes it then she better say YES!!"

Since then, the couple had been hard at work planning their wedding. On Nov. 12, Faison, who currently stars on The Exes, Tweeted that they were tasting cocktails to be served on the big day.

"Alcohol tasting for the wedding!" he wrote, adding a photo of the drinks. "The [sic] Ain't Say It Was Going To Be Like This!!!"

This is the first marriage for Cobb. Faison was previously married to Lisa Askey, with whom he has three children. (He also has a son from a previous relationship.)

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Experts: No link between Asperger's, violence

NEW YORK (AP) — While an official has said that the 20-year-old gunman in the Connecticut school shooting had Asperger's syndrome, experts say there is no connection between the disorder and violence.

Asperger's is a mild form of autism often characterized by social awkwardness.

"There really is no clear association between Asperger's and violent behavior," said psychologist Elizabeth Laugeson, an assistant clinical professor at the University of California, Los Angeles.

Little is known about Adam Lanza, identified by police as the shooter in the Friday massacre at a Newtown, Conn., elementary school. He fatally shot his mother before going to the school and killing 20 young children, six adults and himself, authorities said.

A law enforcement official, speaking on condition of anonymity because the person was not authorized to discuss the unfolding investigation, said Lanza had been diagnosed with Asperger's.

High school classmates and others have described him as bright but painfully shy, anxious and a loner. Those kinds of symptoms are consistent with Asperger's, said psychologist Eric Butter of Nationwide Children's Hospital in Columbus, Ohio, who treats autism, including Asperger's, but has no knowledge of Lanza's case.

Research suggests people with autism do have a higher rate of aggressive behavior — outbursts, shoving or pushing or angry shouting — than the general population, he said.

"But we are not talking about the kind of planned and intentional type of violence we have seen at Newtown," he said in an email.

"These types of tragedies have occurred at the hands of individuals with many different types of personalities and psychological profiles," he added.

Autism is a developmental disorder that can range from mild to severe. Asperger's generally is thought of as a mild form. Both autism and Asperger's can be characterized by poor social skills, repetitive behavior or interests and problems communicating. Unlike classic autism, Asperger's does not typically involve delays in mental development or speech.

Experts say those with autism and related disorders are sometimes diagnosed with other mental health problems, such as depression, anxiety, bipolar disorder or obsessive-compulsive disorder.

"I think it's far more likely that what happened may have more to do with some other kind of mental health condition like depression or anxiety rather than Asperger's," Laugeson said.

She said those with Asperger's tend to focus on rules and be very law-abiding.

"There's something more to this," she said. "We just don't know what that is yet."

After much debate, the term Asperger's is being dropped from the diagnostic manual used by the nation's psychiatrists. In changes approved earlier this month, Asperger's will be incorporated under the umbrella term "autism spectrum disorder" for all the ranges of autism.

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AP Writer Matt Apuzzo contributed to this report.

___

Online:

Asperger's information: http://1.usa.gov/3tGSp5

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Wall St Week Ahead: Holiday "on standby" as clock ticks on cliff

NEW YORK (Reuters) - The last two weeks of December are traditionally quiet for stocks, but traders accustomed to a bit of time off are staying close to their mobile devices, thanks to the "fiscal cliff."

Last-minute negotiations in Washington on the so-called fiscal cliff - nearly $600 billion of tax increases and spending cuts set to take effect in January that could cause a sharp slowdown in growth or even a recession - are keeping some traders and analysts from taking Christmas holidays because any deal could have a big impact on markets.

"A lot of firms are saying to their trading desks, 'You can take days off for Christmas, but you are on standby to come in if anything happens.' This is certainly different from previous years, especially around this time of the year when things are supposed to be slowing down," said J.J. Kinahan, chief derivatives strategist at TD Ameritrade in Chicago.

"Next week is going to be a Capitol Hill-driven market."

With talks between President Barack Obama and House Speaker John Boehner at an apparent standstill, it was increasingly likely that Washington will not come up with a deal before January 1.

Gordon Charlop, managing director at Rosenblatt Securities in New York, will also be on standby for the holiday season.

"It's a 'Look guys, let's just rotate and be sensible" type of situation going on," Charlop said.

"We are hopeful there is some resolution down there, but it seems to me they continue to walk that political tightrope... rather than coming up with something."

Despite concerns that the deadline will pass without a deal, the S&P 500 has held its ground with a 12.4 percent gain for the year. For this week, though, the S&P 500 fell 0.3 percent.

BEWARE OF THE WITCH

This coming Friday will mark the last so-called "quadruple witching" day of the year, when contracts for stock options, single stock futures, stock index options and stock index futures all expire. This could make trading more volatile.

"We could see some heavy selling as there is going to be a lot of re-establishing of positions, reallocation of assets before the year-end," Kinahan said.

RETHINKING APPLE

Higher tax rates on capital gains and dividends are part of the automatic tax increases that will go into effect next year, if Congress and the White House don't come up with a solution to avert the fiscal cliff. That possibility could give investors an incentive to unload certain stocks in some tax-related selling by December 31.

Some market participants said tax-related selling may be behind the weaker trend in the stock price of market leader Apple . Apple's stock has lost a quarter of its value since it hit a lifetime high of $705.07 on September 21.

On Friday, the stock fell 3.8 percent to $509.79 after the iPhone 5 got a chilly reception at its debut in China and two analysts cut shipment forecasts. But the stock is still up nearly 26 percent for the year.

"If you owned Apple for a long time, you should be thinking about reallocation as there will be changes in taxes and other regulations next year, although we don't really know which rules to play by yet," Kinahan said.

But one indicator of the market's reduced concern about the fiscal cliff compared with a few weeks ago, is the defense sector, which will be hit hard if the spending cuts take effect. The PHLX Defense Sector Index <.dfx> is up nearly 13 percent for the year, and sits just a few points from its 2012 high.

(Reporting by Angela Moon; Additional reporting by Chuck Mikolajczak; Editing by Jan Paschal)

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Currents: School Takes New Tack on Work Study

NEW YORK — “I was raised into believing that money is everything,” said Maire Mendoza, 19, crying at her own tale.

Her parents are near-invisibles in this city that they’ve heard called a city of dreams. They left Mexico before Maire was born and have toiled anonymously ever since — her mother a baby sitter these days, her father a restaurant worker.

They raised their girls as pragmatic survivors. So it was startling when Maire came to them not long ago with an epiphany: “I now know that I don’t want to work for money,” she said, to bafflement. But her father, sensing his limitations, deferred. “You’re probably right,” she remembers him saying, “and it’s because you go to school and you know things that we don’t know.”

Ms. Mendoza’s self-discovery was no accident. Such discoveries are the goal of an audacious experiment in New York that seeks to improve the fortunes of community college students by demolishing and rebuilding their perceptions about work.

Community colleges are the bedrock of American higher education. They often take all comers — clever teenagers, 25-year-old ex-drifters, middle-aged downsizees in need of retraining — and let them study as needed: a class at a time or a full load, for a degree or for fun. In a nation whose mythology declaims that all who try can make it, community colleges are among the last hopes of proving the mythology true.

But their anything-goes approach has come under fire in recent years, in part because of dismal graduation rates, which can hover in the twenties, teens or even single digits in some cases.

“The job the country needs community colleges to do now (better success) is different from the job needed from them (broader access) when the community college movement began,” said Allan C. Golston, president of the U.S. program of the Bill and Melinda Gates Foundation, which has pressed for major reforms.

Thanks in part to the reformers’ pressure, the New Community College opened here this autumn, with Ms. Mendoza in the inaugural class. It is an experimental institution within the City University of New York, with a mission to take the students whom community colleges usually fail — they’re still taken first-come, first-serve, not by application — and hugely lift their trajectories.

The college pulls on many levers to achieve that goal — requiring students to be full-timers; limiting courses of study to six fields with proven job prospects; offering abundant counseling. But the most intriguing idea may be a mandatory first-year class called “Ethnographies of Work.”

The course grew out of findings that students who attend community colleges — who in New York come overwhelmingly from low-income or minority backgrounds — often harbor negative associations with work, said Nancy Hoffman, an education scholar who has advised the new college. In these students’ communities, work may be primarily experienced as soul-crushing or exploitative or elusive or illegal.

“Mostly in my community, it’s just to survive,” said Jesus A. Paredes, 18, another first-year student at the New Community College. “Nobody really followed their passion. Or if they did follow their passion, it didn’t go right.”

And so, for their ethnography class this autumn, students fanned out across New York to investigate work. They sat in offices and recorded observations (how workers dressed, their mood, how authority was expressed). They interviewed lawyers, social workers, techies. They kept journals about their own attitudes. The purpose was to reach a deeper understanding of what work is (the topic of their final paper), and how — as Ms. Mendoza was seeking to do — to reconcile the impulse to survive with one’s passions.

“Work is something people do and get paid for,” one student wrote in her final paper. “Work is the foundation of purpose,” said another.

For Jeslyn Ruiz, 18, the class gave her the courage to tell her grandmother that, no, she won’t be a nurse; she wants to be a lighting director for concerts. Her grandmother, who came to the United States from Puerto Rico, laughed in her face. “Oh, no, you’ll be a nurse,” she said, not commanding, just mournfully predicting.

Sherine Smith, 21, came to the course with the notion that “I have to make the most money possible” doing the least possible work. Meeting real-life workers had convinced her that money may not leave you better off and was forcing her to reconsider.

Out of nine students who gathered to meet with a reporter, six said they emerged from the class persuaded that job and passion must align. Derek Norman, a 22-year-old musician who wants to join the Fire Department and confine his music to after-hours gigs, spoke for the keep-them-separate camp: “I don’t feel that you need to take the two of them and mend them together.”

Some of the students seemed less sure of their ultimate direction but were still savoring a strange and stirring semester. For Mr. Paredes, a denizen of this most vertical of cities whom fate has kept close to the ground floor, the homework to interview a successful lawyer delivered on a long-deferred dream: “I’ve never been to a 52nd floor,” he said. He quite liked it up there.

Join an online conversation at http://anand.ly; Follow on Twitter.com/anandwrites

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Games top App Store revenue in 2012

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Gunman's Father and Brother Are 'in Shock,' Says a Source

By Diane Herbst

12/14/2012 at 08:50 PM EST

State police personnel lead children to safety away from the Sandy Hook Elementary School

Shannon Hicks/Newtown Bee/Reuters/Landov

The father and older brother of the gunman who was blamed for the Connecticut school shooting are being questioned by authorities but are not suspects, a law enforcement source tells PEOPLE.

The Associated Press reports that the gunman has been identified as 20-year-old Adam Lanza.

His unidentified father, who lives in New York City, and his older brother, Ryan, 24, of Hoboken, N.J., are "in shock," the law enforcement source tells PEOPLE.

They were being questioned by the FBI in the Hoboken police station but "are not suspects, they have no involvement," the source says.

"Imagine the 24 year old – he's lost his mother. Imagine the father, his son killed 20 kids," the source says."   

As for Adam, "It looks like there's mental history there," the law enforcement source says.

Adam Lanza died at the scene of the shooting that killed 20 children and six adults at the Sandy Hook Elementary School in Newtown, Conn.

His mother, Nancy Lanza, was found dead at her home, according to CNN.

The source describes the weapons used by Lanza as "legitimate." According to CNN, Lanza used two hand guns that were registered to his mother and a rifle.

Adam's parents were no longer together, the source says.   

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Fewer health care options for illegal immigrants

ALAMO, Texas (AP) — For years, Sonia Limas would drag her daughters to the emergency room whenever they fell sick. As an illegal immigrant, she had no health insurance, and the only place she knew to seek treatment was the hospital — the most expensive setting for those covering the cost.

The family's options improved somewhat a decade ago with the expansion of community health clinics, which offered free or low-cost care with help from the federal government. But President Barack Obama's health care overhaul threatens to roll back some of those services if clinics and hospitals are overwhelmed with newly insured patients and can't afford to care for as many poor families.

To be clear, Obama's law was never intended to help Limas and an estimated 11 million illegal immigrants like her. Instead, it envisions that 32 million uninsured Americans will get access to coverage by 2019. Because that should mean fewer uninsured patients showing up at hospitals, the Obama program slashed the federal reimbursement for uncompensated care.

But in states with large illegal immigrant populations, the math may not work, especially if lawmakers don't expand Medicaid, the joint state-federal health program for the poor and disabled.

When the reform has been fully implemented, illegal immigrants will make up the nation's second-largest population of uninsured, or about 25 percent. The only larger group will be people who qualify for insurance but fail to enroll, according to a 2012 study by the Washington-based Urban Institute.

And since about two-thirds of illegal immigrants live in just eight states, those areas will have a disproportionate share of the uninsured to care for.

In communities "where the number of undocumented immigrants is greatest, the strain has reached the breaking point," Rich Umbdenstock, president of the American Hospital Association, wrote last year in a letter to Obama, asking him to keep in mind the uncompensated care hospitals gave to that group. "In response, many hospitals have had to curtail services, delay implementing services, or close beds."

The federal government has offered to expand Medicaid, but states must decide whether to take the deal. And in some of those eight states — including Texas, Florida and New Jersey — hospitals are scrambling to determine whether they will still have enough money to treat the remaining uninsured.

Without a Medicaid expansion, the influx of new patients and the looming cuts in federal funding could inflict "a double whammy" in Texas, said David Lopez, CEO of the Harris Health System in Houston, which spends 10 to 15 percent of its $1.2 billion annual budget to care for illegal immigrants.

Realistically, taxpayers are already paying for some of the treatment provided to illegal immigrants because hospitals are required by law to stabilize and treat any patients that arrive in an emergency room, regardless of their ability to pay. The money to cover the costs typically comes from federal, state and local taxes.

A solid accounting of money spent treating illegal immigrants is elusive because most hospitals do not ask for immigration status. But some states have tried.

California, which is home to the nation's largest population of illegal immigrants, spent an estimated $1.2 billion last year through Medicaid to care for 822,500 illegal immigrants.

The New Jersey Hospital Association in 2010 estimated that it cost between $600 million and $650 million annually to treat 550,000 illegal immigrants.

And in Texas, a 2010 analysis by the Health and Human Services Commission found that the agency had provided $96 million in benefits to illegal immigrants, up from $81 million two years earlier. The state's public hospital districts spent an additional $717 million in uncompensated care to treat that population.

If large states such as Florida and Texas make good on their intention to forgo federal money to expand Medicaid, the decision "basically eviscerates" the effects of the health care overhaul in those areas because of "who lives there and what they're eligible for," said Lisa Clemans-Cope, a senior researcher at the Urban Institute.

Seeking to curb expenses, hospitals might change what qualifies as an emergency or cap the number of uninsured patients they treat. And although it's believed states with the most illegal immigrants will face a smaller cut, they will still lose money.

The potential impacts of reform are a hot topic at MD Anderson Cancer Center in Houston. In addition to offering its own charity care, some MD Anderson oncologists volunteer at a county-funded clinic at Lyndon B. Johnson General Hospital that largely treats the uninsured.

"In a sense we've been in the worst-case scenario in Texas for a long time," said Lewis Foxhall, MD Anderson's vice president of health policy in Houston. "The large number of uninsured and the large low-income population creates a very difficult problem for us."

Community clinics are a key part of the reform plan and were supposed to take up some of the slack for hospitals. Clinics received $11 billion in new funding over five years so they could expand to help care for a swell of newly insured who might otherwise overwhelm doctors' offices. But in the first year, $600 million was cut from the centers' usual allocation, leaving many to use the money to fill gaps rather than expand.

There is concern that clinics could themselves be inundated with newly insured patients, forcing many illegal immigrants back to emergency rooms.

Limas, 44, moved to the border town of Alamo 13 years ago with her husband and three daughters. Now single, she supports the family by teaching a citizenship class in Spanish at the local community center and selling cookies and cakes she whips up in her trailer. Soon, she hopes to seek a work permit of her own.

For now, the clinic helps with basic health care needs. If necessary, Limas will return to the emergency room, where the attendants help her fill out paperwork to ensure the government covers the bills she cannot afford.

"They always attended to me," she said, "even though it's slow."

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Sherman can be followed on Twitter at https://twitter.com/chrisshermanAP .

Plushnick-Masti can be followed on Twitter at https://twitter.com/RamitMastiAP .

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