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

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Connecticut Shooting: Bodies Removed from School, Positively Identified

By Mike Fleeman

12/15/2012 at 10:25 AM EST

Connecticut State Police Lt. J. Paul Vance

Mary Altaffer/AP

A horrific day turned to a night of unspeakable grief as parents received formal notifications that their children were killed in the Connecticut school massacre.

The last of the dozens of bodies – most of them children – were removed by early Saturday from Sandy Hook Elementary School in Newtown, Conn.

"Our objective certainly was to positively identify the victims to try to give the families some closure," State Police Spokesman Lt. Paul Vance tells CBS News. "Our detectives worked well through the night. By early this morning, we were able to positively identify all of the victims and make some formal notification to all of the families of the victims."

The gunman, identified by multiple law enforcement sources as 20-year-old Adam Lanza, killed 20 children between the ages of 5 and 10 and six adults, before taking his own life at the school. His mother also was killed at a different location, bringing the total death toll to 28.

Eighteen children were pronounced dead at the scene and two at the hospital; six adult victims were pronounced dead at the scene, the Los Angeles Times reports.

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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 .

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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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News Analysis: China Stays Beside North Korea, a Buffer Against the U.S.

BEIJING — Even though North Korea ignored China’s appeal not to test its new longer-range missile, the new leadership here appears intent on remaining a steadfast supporter of its wayward neighbor because it considers the North a necessary buffer against the United States and its allies.

Analysts said that China’s overriding fear was of a collapse of the hard-line Communist government in Pyongyang, which could lead to the reunification of the Korean Peninsula under a government in Seoul allied with the United States. China, they said, would consider an American presence on its doorstep untenable.

But China’s unyielding support of Kim Jong-un has a serious downside, they added, because it may lead to a result nearly as unpalatable: efforts by the United States and its regional allies Japan and South Korea to contain China.

“It stirs up regional security,” said Zhu Feng, a professor of international relations at Peking University who favors reducing support for North Korea. Without naming the United States, he added that the missile launching “facilitates China-bashers to work on hard-line policies to contain China, or just balance China.”

Obama administration officials were clearly exasperated this week with China’s inability to rein in Mr. Kim, saying that they were considering a stronger military presence in the Asia-Pacific region.

Beneath the official tolerance of North Korea, a debate about the wisdom of remaining loyal to such a world outlier and its defiant young leader simmers among analysts who strive to influence China’s foreign policy.

China runs the risk, Dr. Zhu said, of being bunched together with North Korea as one of “the two bad guys.”

“I feel very frustrated,” Dr. Zhu added. “At least we should distance ourselves from North Korea. The reality is, as long as North Korea can’t change their behavior, then peace and stability on the peninsula will be increasingly vulnerable.”

China has twice asked Mr. Kim, who inherited the leadership of North Korea after the death of his father at the end of last year, not to proceed with missile tests, and twice he has rebuffed the entreaties. Shortly after he came to power, a Chinese vice minister of foreign affairs, Fu Ying, visited Pyongyang to warn him not to conduct a test. In April, Mr. Kim went ahead anyway with a rocket launching, which fizzled. Last month, Li Jianguo, a member of the Politburo, visited North Korea to again urge restraint.

Despite their displeasure, China’s leaders see little choice but to put up with such indignities.

The slight pique expressed by the Foreign Ministry on Wednesday was not a signal that China would alter its course, the analysts said, or back tougher sanctions at the United Nations.

The official reaction was “very hesitant,” said Jin Canrong, a professor of international relations at Renmin University in Beijing.

After the missile test, Washington immediately started pushing for deeper sanctions at the United Nations and for a tightening of existing sanctions that China agreed to after earlier rocket launchings.

“China will not support a resolution; it will favor a president’s statement,” said Cai Jian, the deputy director of the Center for Korean Studies at Fudan University in Shanghai. A president’s statement at the United Nations is considered a much weaker form of condemnation than sanctions.

A major reason for not backing new sanctions is the fear that they would provoke North Korea to test another nuclear weapon, a far worse prospect than the launching of an unarmed rocket like the one on Wednesday, said Jonathan D. Pollack, a North Korea expert at the Brookings Institution in Washington.

“The North Koreans demurred from a third nuclear test in April, very likely under major Chinese pressure,” Dr. Pollack said.

In 2006 and 2009, North Korea tested a nuclear weapon soon after launching missiles. Dr. Pollack said a repeat of that action would pose a major test to the Obama administration, as well as to the new Chinese leader, Xi Jinping.

“Pyongyang may have decided now is the time to put down a major marker as Obama’s second term approaches and as South Korea elects a new president,” he said.

Beyond the hard strategic questions for the new Chinese leadership, the concerns among ordinary Chinese about why China bankrolls such a ruthless government should be considered, several Chinese analysts said.

“Internally in China, many voices are questioning all this spending on rocket launches instead of on improving people’s livelihoods,” said Jia Qingguo, an expert at Peking University.

The South Korean government recently estimated that North Korea had spent $2.8 billion to $3.2 billion since 1998 on its missile program, said Stephan M. Haggard, a professor of Korea-Pacific studies at the University of California, San Diego. That amount of money would have bought enough corn to feed the country for about three years, Dr. Haggard said.

The debate within China about its relationship with North Korea stems from the unusual nature of the alliance. Fundamentally, the two governments do not like each other and harbor deep mutual suspicions, said Stephanie T. Kleine-Ahlbrandt, the China and Northeast Asia project director of the International Crisis Group in Beijing. When North Korean officials visited Singapore this year to get new ideas for Mr. Kim’s government, leaders in Beijing — who have sent teams of their own to Singapore to study its softer form of one-party leadership — became very nervous, she said.

The larger fear is that any fundamental change in North Korea could send waves of refugees into China, who would be considerably more difficult to absorb than people of other nationalities on China’s borders.

“For the Chinese,” Ms. Kleine-Ahlbrandt said, “there are fewer problems keeping North Korea the way it is than having a collapse.”

Bree Feng contributed research.

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The Hobbit Is a Great Adventure That Takes Too Long to Arrive

By Alynda Wheat

12/14/2012 at 10:00 AM EST

    

The elegance of The Hobbit J.R.R. Tolkien's rousing tale of Bilbo Baggins helping a passel of dwarves reclaim their mountain home is that the epic spans just a few hundred pages.

Moviegoers, on the other hand, could have first breakfast, second breakfast and elevenses in the nearly three hours it takes director Peter Jackson to deliver the first third of this trilogy in The Hobbit: An Unexpected Journey. (Part 2 is slated for next year.)

It helps that the cast is so engaging, particularly Martin Freeman as Bilbo, a kind, fussy sort torn between the comforts of his divinely cozy hobbit hole and the promise of adventure.

And what adventure it is!

Bilbo, wizard Gandalf (Ian McKellen) and the dwarves take on Middle-Earth beasts in glorious 3D battles. (Note: Viewers prone to vertigo should see the film in the old-school 24 frames-per-second format.)

Like The Lord of the Rings, The Hobbit is violent, but there are sillier bits meant to appeal to kids. Whether they can stick it out through elevenses is another matter.

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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..