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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In Brazil, Caves Would Be Lost in Mining Project

Lalo de Almeida for The New York Times

A speleologist from Vale, the Brazilian mining giant, in October at a cave in the Carajás Mountains, where it plans to expand an iron-ore mining complex.

CARAJÁS NATIONAL FOREST, Brazil — Archaeologists must climb tiers of orchid-encrusted rain forest, where jaguars roam and anacondas slither, to arrive at one of the Amazon’s most stunning sights: a series of caves and rock shelters guarding the secrets of human beings who lived here more than 8,000 years ago.

Almost anywhere else, these caves would be preserved as an invaluable source of knowledge into prehistoric human history. But not in this remote corner of the Amazon, where Vale, the Brazilian mining giant, is pushing forward with the expansion of one of the world’s largest iron-ore mining complexes, a project that will destroy dozens of the caves treasured by scholars.

The caves, and the spectacular mineral wealth in their midst, have presented Brazil with a dilemma. The iron ore from Carajás, exported largely to China where it is used to make steel, is a linchpin of Brazil’s ambitions of reviving a sluggish economy, yet archaeologists and other researchers contend that the emphasis on short-term financial gains imperils an unrivaled window into a nebulous past.

“This is a crucial moment to learn about the human history of the Amazon, and by extension the peopling of the Americas,” said Genival Crescêncio, a caver and historian in Pará State, which includes Carajás. “We should be preserving this unique place for science, but we are destroying it so the Chinese can open a few more car factories.”

As Brazil embarks on a frenzied effort to increase mining and improve infrastructure, work crews in the Amazon and beyond are unearthing one startling discovery after another. In Rio de Janeiro, archaeologists are examining a slave market and cemetery where thousands of Africans were buried. The discoveries have complicated the upgrade of the harbor and public transportation network ahead of the 2016 Olympic Games.

Brazilian courts can require companies to preserve archaeological sites, or at least transfer archaeological material to universities or museums where it can be studied, before work continues. In some cases, rulings have stalled huge projects, as Anglo American, the mining giant, discovered this year when prosecutors halted work on a large mining project in Minas Gerais State over concerns that an archaeologically significant cave could be damaged.

Scholars say that the caves of Carajás, which archaeologists began exploring in the 1980s, offer coveted insight into what may be the earliest known stages of human settlement in the world’s largest tropical rain forest, helping to piece together the puzzle of how the Americas came to be inhabited.

Pieces of ceramic vessels and tools made of amethyst and quartz are among the signs of human occupation from thousands of years ago. Such artifacts, along with the abundance of the caves and rock shelters themselves, make Carajás one of the Amazon’s most important places for the study of prehistoric humans.

The Amazon is already a hotbed of archaeological investigation, as researchers find evidence that far more people might have lived in the region than once considered possible. While the Amazon was once thought incapable of supporting large, sophisticated societies, researchers now contend that the region might have been home to thriving urban centers before the arrival of Columbus.

Before those cities were carved out of the forest, people lived in the Amazon’s caves. At Pedra Pintada, a cave that, like those in Carajás, is also in Pará, Anna C. Roosevelt, an American archaeologist, has shown that hunter-gatherers moved to the region 10,900 to 11,200 years ago, far earlier than once thought, about the same time people in North American were hunting mammoths.

Outside the Amazon, remarkable discoveries have been announced in recent months at other Brazilian sites. At Lapa do Santo, a rock shelter near the city of Belo Horizonte, archaeologists said this year that they had found the New World’s oldest known figurative petroglyph. The rock art, a drawing of a man with an oversize phallus, is thought to have been made 10,500 to 12,000 years ago.

To reach the caves of Carajás, researchers must drive hours along washboard roads cut through the jungle, before scaling escarpments with spectacular views of the Carajás Mountains, a range of canopied peaks rising out of the forest. Macaws fly overhead and bats swirl inside the earth cavities in which hunting tribes once found shelter.

Some of the caves, substantially cooler inside their openings than the surrounding forest, are large enough for more than a dozen people; others might have provided just enough space for two or three people.

Vale, then a state-owned company, began developing the iron ore deposits here after they were discovered in 1967 by a Brazilian geologist on assignment to find manganese for the U.S. Steel Corporation. Vale has since been privatized, but the government still controls big equity stakes.

Thanks largely to its Carajás complex, where thousands of workers labor 24 hours a day amid the clamor of digging machines, Vale accounts for 16 percent of Brazil’s total exports. As Vale grapples with a sharp decline in profits this year and delays at projects outside Brazil, Carajás is expected to become more important.

Vale has said it plans to create 30,000 jobs in the expansion of iron-ore mining at Carajás, a $20 billion project called Serra Sul, which is already luring thousands of migrants from around Brazil to this frenetic part of the Amazon.

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RIM shows how BlackBerry 10 touch screen keys could rival even its traditional keyboards [video]

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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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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."

___

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

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

Read More..

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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Changing of the Guard: Chinese Opposition to Labor Camps Widens

BEIJING — It is hard to say exactly which “subversive” sentiments drew the police to Ren Jianyu, who posted them on his microblog last year, although “down with dictatorship” and “long live democracy” stand out.

In the end, Mr. Ren, 25, a college graduate from Chongqing, the southwestern metropolis, was sent without trial to a work camp based on the T-shirt that investigators found in his closet: “Freedom or death,” it said.

Last year Mr. Ren was among tens of thousands of Chinese who were dumped into the nation’s vast “re-education through labor” system, a Stalinist-inspired constellation of penal colonies where pickpockets, petitioners, underground Christian church members and other perceived social irritants toil in dismal conditions for up to four years, all without trial. With as many as 190,000 inmates at any one time, it is one of the world’s largest systems of forced labor.

But now the labor system, known by its shorthand, “laojiao,” is facing a groundswell of opposition from both inside and outside the Communist Party. Critics say the once-in-a-decade leadership transition last month, which included the demotion of the chief of the nation’s vast internal security apparatus, has created a potential opening for judicial and legal reform.

“It’s high time we demolish this unconstitutional and abusive system that violates basic human rights, fuels instability and smears the government’s image,” said Hu Xingdou, a professor at the Beijing Institute of Technology who frequently rails against the system that Mao Zedong created in the 1950s to take down suspected class enemies and counterrevolutionaries.

The calls for change go beyond longstanding advocates of political reform like Professor Hu. China’s national bar association is circulating an online petition that has been signed by thousands. Legal experts have convened seminars to denounce the system. And almost every day, it seems, the state-run news media, with the top leadership’s tacit support, report on hapless citizens ensnared by the arbitrary justice that the local police impose with the wave of a hand.

Mr. Ren’s case would probably have gone unnoticed if not for China’s increasingly emboldened human rights defenders, who showcased his plight on the Internet. Evidently prodded by the torrent of news coverage, Chongqing officials cut short his two-year sentence and freed him.

“It was a depressing, dreadful experience,” Mr. Ren said in a telephone interview this month, describing long days spent in the camp’s wire-coiling workshop.

Other examples abound. A migrant worker from Inner Mongolia was sent away for quarreling with an official at a restaurant. A mother from Hunan Province was given an 18-month sentence after she publicly protested that the men who had raped and forced her 11-year-old daughter into prostitution had been treated too leniently.

This month an 80-year-old Korean War veteran with Parkinson’s disease sobbed on national television as he described spending 18 months in a labor camp as punishment for filing local corruption complaints.

People’s Daily, the Communist Party’s mouthpiece, took aim at the system last month, saying it had become “a tool of retaliation” for local officials. In October the head of a government judicial reform committee noted a broad consensus in favor of addressing the system’s worst abuses.

And in a widely circulated recent essay, the vice president of the Supreme People’s Court, Jiang Bixin, argued that the government must act within the law if it is to survive. “Only with constraints on public power can the rights and freedoms of citizens be securely realized,” he wrote.

China’s incoming president, Xi Jinping, has not yet weighed in on the issue, but reform advocates are encouraged by a speech he gave this month talking up the widely ignored protections afforded by China’s Constitution, which include freedom from unlawful detention and the right to an open trial. “We must establish mechanisms to restrain and supervise power,” Mr. Xi said.

Until now, China’s powerful security establishment has staved off any erosion of its authority, warning of calamity if the police lose their ability to detain perceived troublemakers without the interference of judges or defense lawyers.

The Ministry of Public Security has other reasons to preserve the status quo. The system, which employs tens of thousands of people, is a gold mine for local authorities, who earn money from the goods produced by detainees. Officials also covet the bribes offered to reduce sentences, critics say, and the payments families make to ensure a loved one is properly fed while in custody.

Patrick Zuo contributed research.

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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.   

Read More..

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."

___

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

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

Read More..