Daniel Inouye, Longtime Hawaii U.S. Senator, Dies at 88

12/17/2012 at 06:45 PM EST

Daniel Inouye, Hawaii's nine-term Democratic Senator and the highest-ranking Asian-American politician in American history, died Monday at age 88 of respiratory complications.

His office said the Honolulu native's last word was "Aloha."

A second-generation "Nisei" born in 1924, Inouye was a World War II hero who lost most of his right arm to a German grenade in Italy but continued firing his gun with his good arm. He later received the Medal of Honor.

A lawyer, he became the first Japanese-American elected to the House in 1959, the same year Hawaii became a state. Three years later, he was elected to the Senate, eventually becoming the second longest serving member after West Virginia Democratic Sen. Robert Byrd, who died in 2010.

He gave the keynote address at the contentious 1968 Democratic National Convention in Chicago, served on the Senate Watergate Committee, whose hearings led to President Nixon's downfall, and chaired the committee investigating the Iran-Contra Affair during the Reagan Administration.

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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.

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Online:

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

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Optimism about "cliff" boost market; financials lead

NEW YORK (Reuters) - The S&P 500 ended at its highest level in almost two months on Monday on rising hopes that negotiations over the "fiscal cliff" were making progress and that a deal could be reached in days.

After weeks of stalemate, President Barack Obama and Republican House Speaker John Boehner met at the White House on Monday, raising hopes that Washington will be able to head off steep tax hikes and spending cuts that threaten the economy.

All of the S&P 500's 10 sectors were higher, led by financials and other growth-oriented sectors. The S&P Financial Index <.gspf> gained 2.1 percent, and shares of Bank of America jumped 4 percent to $11. In a research note Monday, Meredith Whitney Advisory Group shifted to a positive stance on financials and upgraded Bank of America, Citigroup and Discover Financial shares.

The S&P consumer distretionary index <.gspd>, up 1.8 percent, was the second-best performing sector. Investors worry the U.S. economy could slide into recession if the tax and spending changes are implemented.

Boehner has edged closer to Obama's position by proposing to extend lower tax rates for everyone who earns less than $1 million. Still, his position remains far from that of President Obama.

"Trumping everything right now are the fiscal cliff talks. It seems like progress is being made. I think it's getting to the nitty gritty," said Alan Lancz, president of Alan B. Lancz & Associates Inc. in Toledo, Ohio. "The bet right now is that something will come by the end of this week."

The Dow Jones industrial average <.dji> was up 100.38 points, or 0.76 percent, at 13,235.39. The Standard & Poor's 500 Index <.spx> was up 16.78 points, or 1.19 percent, at 1,430.36, its highest close since October 22. The Nasdaq Composite Index <.ixic> was up 39.27 points, or 1.32 percent, at 3,010.60.

The gains, which came on lighter-than-usual volume, ended a two-day losing streak on the S&P 500. The index also had its best daily percentage gain since November 23. Volume was roughly 6.2 billion shares traded on the New York Stock Exchange, the Nasdaq and the NYSE MKT, compared with the year-to-date average daily closing volume of 6.4 billion.

In the financial sector, American International Group Inc. shares rose 3 percent to $34.95 on plans to sell as much as $6.5 billion of AIA Group Ltd. Advancing stocks also included those in the home construction sector <.djushb>, which rose 4.5 percent.

"People are looking for sectors to play, and I think Bank of America broke out of some long-standing price levels, and it got everything going in that sector," said Rick Meckler, president of investment firm LibertyView Capital Management in Jersey City, New Jersey.

Shares of Citigroup were up 4.1 percent at $39.15 while shares of Discover Financial were up 1.6 percent at $40.18.

Clearwire Corp agreed to sell the rest of the company to Sprint Nextel Corp for a slightly sweetened $2.2 billion offer just days after minority shareholders criticized the previous bid as too low. Clearwire tumbled 13.6 percent to $2.91, while Sprint was up 0.2 percent to $5.56.

Apple Inc shares edged up after recent losses, rising 1.8 percent to $518.83 even though two firms cut their price targets on the stock Monday.

The tech giant said it sold more than 2 million of its new iPhone 5 smartphones in China during the three days after its launch there on Friday, but the figures did not ease worries about stiffer competition. Apple shares have tumbled more than 25 percent in about three months.

Compuware Corp rose 12.9 percent to $10.76 after hedge fund Elliott Management offered to buy the business software maker for $2.3 billion and S&P Capital IQ raised the target price and moved it to "hold" from "strong sell.

Advancers outnumbered decliners on the NYSE by about 2 to 1, and on the Nasdaq by nearly 9 to 4.

(Editing by Kenneth Barry and Nick Zieminski)

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Syrians Airstrike Kills Palestinian Refugees

DAMASCUS, Syria — Government forces for the first time hit Syria’s largest Palestinian refugee neighborhood with airstrikes on Sunday, killing at least eight people in the Yarmouk district of Damascus and driving dozens of formerly pro-government Palestinian fighters to defect to the rebels, fighters there said.

The New York Times

For many Yarmouk residents — refugees from conflict with Israel and their descendants — the attacks shattered what was left of the Syrian government’s claim to be a champion and protector of Palestinians.

New signs emerged on Sunday of political pressure on President Bashar al-Assad. Mr. Assad’s vice president was quoted as saying that neither side could win the war and calling for “new partners” in a unity government, a possible sign that at least some in the government were exploring new ways out of the crisis. The comments came as two close allies, the government of Iran and the leader of the Lebanese Shiite group Hezbollah, appeared to slightly temper their support.

In Yarmouk, burned body parts littered the ground at the Sheik Abdul Qader mosque, which had offered shelter to Palestinians and others displaced by fighting in other areas. Minutes before, a Syrian fighter jet fired rockets at the camp. Women, crying children and white-bearded men thronged the streets with hurriedly packed bags, not sure where to look for safety.

For many Yarmouk residents — refugees from conflict with Israel and their descendants — the attacks shattered what was left of the Syrian government’s claim to be a champion and protector of Palestinians, a position the Assad family relied upon as a source of domestic and international legitimacy in more than 40 years of iron-fisted rule.

“For decades the Assad regime was talking about the Palestinians’ rights,” said a Palestinian refugee who gave his name as Abu Ammar as he debated whether to flee with his wife and five children from the camp, on the southern edge of Damascus. “But Bashar al-Assad has killed more of us today than Israel did in its latest war on Gaza.”

He added: “What does Bashar expect from us after today? All of us will be Free Syrian Army fighters.”

The Palestinian militant group and political party Hamas has broken with Mr. Assad over his crackdown on what began as a peaceful protest movement, and while most Palestinian parties still profess neutrality, a growing number of Palestinians support — and have even joined — the rebels.

The Syrian government long held the loyalty of hundreds of thousands of Palestinian refugees, giving them health care, education and access to professional careers, among other rights denied by other Arab host countries. But those policies also gave Palestinians a stake and sense of belonging in Syria that have led many to support the uprising.

Several of Mr. Assad’s allies signaled a new push for a peaceful solution. Iran’s Foreign Ministry called for an end to military action, the release of political prisoners and a broad-based dialogue to form a transitional government that would hold free elections, Iran’s state news agency reported.

Mr. Assad’s vice president, Farouk al-Sharaa, said that neither the government nor the rebels could end the conflict militarily, the pro-Syrian Lebanese newspaper Al Akhbar reported. And he called for a solution involving a cease-fire and brokered by international leaders that would establish a “national unity government with wide powers.”

He added that the battle was for the country’s very existence, not “the survival of an individual or a regime,” and that Syria’s leaders “cannot achieve change without new partners.”

The impact of the statements was unclear. Mr. Sharaa, a Sunni Muslim like most of the rebels, has been floated by the Arab League as a possible successor, but many of Mr. Assad’s opponents reject any dealings with leaders of the current government.

In neighboring Lebanon, Hassan Nasrallah, the leader of Hezbollah, appeared to acknowledge for the first time that the Syrian uprising is at least in part driven by popular sentiment.

“Today, in Syria,” he said in a videotaped address at a graduation ceremony, “there is a big part of the population with the Syrian regime and a part against it, and the latter armed themselves to fight the regime.”

An employee of The New York Times reported from Damascus, and Anne Barnard from Beirut, Lebanon. Hania Mourtada contributed reporting from Beirut, and Hala Droubi from Dubai.

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Newtown Shooting Victims: Their Photos, Their Lives

When his mother told him she loved him, Noah replied, "Not as much as I love you, Mom," said his uncle, according to the AP. In another classroom, his twin sister, whom he called his best friend, survived the shooting. Along with their older sister, 8-year-old Sophia, the siblings were inseparable. "He was just a really lively, smart kid," added his uncle. "He would have become a great man, I think. He would have grown up to be a great dad." Photo: Family photo/AP

NEXT PHOTO

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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.

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Online:

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

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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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Hillary Clinton Suffers a Concussion After Fainting

WASHINGTON — Secretary of State Hillary Rodham Clinton suffered a concussion early last week after fainting and striking her head, the State Department disclosed on Saturday.

As a result, Mrs. Clinton will not testify as scheduled on Thursday before Congressional committees investigating the September attack on the American diplomatic outpost in Benghazi, Libya.

The fainting episode occurred after Mrs. Clinton, who is being widely discussed as a possible presidential candidate in 2016, became dehydrated because of a stomach virus she contracted during a trip to Europe, according to statements released by Philippe Reines, a close adviser to Mrs. Clinton, and by her doctors.

“Secretary Clinton developed a stomach virus, leading to extreme dehydration, and subsequently fainted,” her doctors, Dr. Lisa Bardack of the Mount Kisco Medical Group and Dr. Gigi El-Bayoumi of George Washington University, said in their statement on Saturday. “Over the course of this week we evaluated her and ultimately determined she had also sustained a concussion.”

One State Department official said Mrs. Clinton fainted when she was alone at her home in Washington but added that the concussion was not diagnosed until Thursday. He said the concussion was not severe.

Acting on the advice of her doctors, Mrs. Clinton will not go to the State Department this week but will work from home, the State Department’s statement said.

William J. Burns and Thomas R. Nides, both deputy secretaries of state, will testify before the Senate Foreign Relations Committee in place of Mrs. Clinton, according to a spokesman for the panel. They are also expected to testify before a House committee about the attack, in which Ambassador J. Christopher Stevens and three other Americans were killed.

Besides the Congressional hearings, the State Department is preparing for an eventful week on the Benghazi attack, which had led to considerable partisan fighting about what precipitated the attack and what arrangements were made to defend the compound.

On Monday, an independent panel that was established to investigate the attack is expected to present its report to the State Department. The panel, called an accountability review board, is led by Thomas R. Pickering, a veteran diplomat. It includes four other members, including Mike Mullen, the retired admiral who formerly served as chairman of the Joint Chiefs of Staff. The board is authorized by a 1986 law intended to strengthen security at United States diplomatic missions.

The State Department plans to share the report with Congress and will also provide its own recommendations on how security for diplomats can be improved. Mr. Pickering and Admiral Mullen are expected to meet with lawmakers in closed sessions on Wednesday.

Then on Thursday, Mr. Burns and Mr. Nides will testify before the Senate committee, which is led by Senator John Kerry, the Massachusetts Democrat who is expected to succeed Mrs. Clinton as secretary of state.

Mrs. Clinton has said that she takes responsibility for the failure to successfully defend the Benghazi compound in the Sept. 11 attack. But she has never been questioned by lawmakers about how decisions were made by the Obama administration to establish the compound and protect it.

When a House oversight committee held a hearing on the Benghazi attack in October, the State Department was represented by a senior management official and a midlevel official from the department’s Bureau of Diplomatic Security. The former chief security officer for the embassy in Libya, Eric A. Nordstrom, told that panel that some of his requests for additional security were ignored. But the State Department’s under secretary for management, Patrick Kennedy, countered that none of the steps proposed by Mr. Nordstrom would have altered the outcome in Benghazi because the embassy was based in Tripoli.

The political debate over the Benghazi attack has already claimed one victim: the ambassador to the United Nations, Susan E. Rice. Ms. Rice had been the Obama administration’s top choice to succeed Mrs. Clinton as secretary of state, but last week she withdrew her name from consideration for the job because of the controversy over her initial description of the attack as a spontaneous demonstration that spun out of control.

On Tuesday, Mrs. Clinton canceled a planned trip to Morocco, where she was expected to formally recognize a new Syrian opposition coalition as the legitimate representative of the Syrian people. President Obama conveyed the recognition instead in an interview with ABC News.

Last week, State Department officials gave a mixed picture about the severity of Mrs. Clinton’s illness. On Wednesday, a State Department spokeswoman, Victoria Nuland, described Mrs. Clinton as having a “very uncomfortable stomach virus.”

The next day, Ms. Nuland said Mrs. Clinton was “under the weather.” Ms. Nuland did say that Mrs. Clinton’s illness had prevented her from making any calls to foreign leaders.

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Connecticut Shooting: Hero Teacher Died Saving Students

By Sara Hammel and Mike Fleeman

12/15/2012 at 06:30 PM EST

Out of the chaos and horror emerged an incredible act of selflessness and bravery by one teacher, who spent her final moments trying to protect her young students from harm.

Victoria Soto, 27, a first-grade teacher at Sandy Hook Elementary School in Newtown, Conn., ushered her students into a closet and in so doing placed her body between them and the assailant.

"She was found huddled over her children, her students, doing instinctively what she knew was the right thing," her cousin Jim Wiltsie tells ABC News. "I'm just proud that Vicki had the instincts to protect her kids from harm,” he continued. “It brings peace to know that Vicki was doing what she loved, protecting the children and in our eyes she's a hero.”

Soto was among the six adults – all women – killed in Friday morning's massacre that also took the lives of 20 children – 12 girls and eight boys. The gunman, identified as 20-year-old Adam Lanza, took his own life. His mother was also found killed in a different location.

"It doesn't surprise me at all she would do this," Sabeena Ali, the parent of a girl who was in Soto's class two years ago, tells PEOPLE.

Ali calls Soto a "vibrant woman who loved the kids and would be with the kids and spend time with them and sit on the floor with them. "

Two years later, her daughter – now a third-grader – still idolized Soto.

"Every day there was some new Miss Soto story we had to listen to: 'This is what she did, this is how wonderful she was today,'" says Ali. "She would bring in snacks for the kids and do special days.

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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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