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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Despite Threat of Steep Fines, Protesters Turn Out in Moscow

Pavel Golovkin/Associated Press

Police officers detained the opposition leader Aleksei Navalny during a rally in Lubyanka Square in Moscow on Saturday.

MOSCOW — Forcing a showdown with the government of President Vladimir V. Putin, leaders of the Russian political opposition took to the streets on Saturday afternoon for an unsanctioned demonstration in a symbolic square in Moscow that is home to the headquarters of the federal security services as well as a monument to victims of Soviet political repression.

Bundled up against the frigid cold and wind, with the temperature hovering at about 5 degrees Fahrenheit and the late December light slashing across a clear sky, about 2,000 demonstrators gathered in Lubyanka Square, not far from the Kremlin. They were met by a huge contingent of riot police officers, who quickly cordoned off the area and began making arrests.

The protest without a permit was a pointed act of defiance, particularly by the two most prominent opposition leaders: Aleksei Navalny, an anticorruption activist, and Sergei Udaltsov of the Left Front, a radical socialist group. Mr. Navalny and Mr. Udaltsov face a growing number of criminal charges and have lived for weeks with the prospect of imminent arrest.

Mr. Udaltsov was seized by the riot police moments after he arrived, at about 3 p.m., and hustled into a police van. “I am not violating any laws,” he shouted as he was taken away. “Russia will be free.”

Mr. Navalny, by contrast, arrived surrounded by a large scrum of photographers and worked the crowd like a politician on a rope line, shaking hands with supporters. He seemed buoyant and carefree and said, “O.K., let’s stand here awhile.” The mob around him seemed to forestall his arrest, but not for long. He was detained about an hour after his arrival.

Other well-known opposition leaders were given no leeway. A television personality, Kseniya Sobchak, and a liberal activist, Ilya Yashin, were arrested immediately after emerging from a nearby cafe. About an hour and a half later, the police began arresting dozens of rank-and-file demonstrators.

The crowd was a fraction of the size of previous rallies this year, suggesting that interest may be waning. The inability of the opposition leaders and the authorities to agree on the terms for a protest permit also suggested that each side’s resolve might be hardening.

By attending the rally, demonstrators showed they were unbowed by a law signed by Mr. Putin in June that imposes steep fines — of more than $9,000 for participants and more than $18,000 for organizers — for taking part in unsanctioned protests.

“Today we showed the authorities that we have principles and dignity, that they cannot forbid us from taking a walk in our own city, because we will come anyway,” said Dmitri Gudkov, one of a small number of Russian lawmakers to support the opposition openly. “There is still protest and we want change, and they can’t frighten us with detention or pressure or searches or arrests or anything else.

“If you want to avoid massive acts of protest, initiate reforms, my friends, and the people will not come out to protests.” By swiftly arresting the main opposition leaders, the authorities seemed to calculate that they would face minimal public reaction, though that is likely to be determined by how severely the opposition members are treated within the judicial system.

The law that increased fines is one of numerous steps Mr. Putin’s government has taken to clamp down on political dissent in the year since evidence of fraud in parliamentary elections last December set off a series of large street demonstrations here.

The early protests were marked by a certain giddiness, as many middle-class Muscovites embraced the newfound spirit of political activism. But with Mr. Putin’s return to the presidency, after a solid victory in elections last March, the space for political dissent has contracted.

The authorities have opened numerous criminal investigations into leaders of the political opposition, carried out repeated searches of their homes and businesses, and filed charges that in some cases could lead to lengthy prison sentences.

On Friday, the authorities announced yet another criminal investigation of Mr. Navalny, accusing him and his brother, Oleg, who is a post office employee, of a strange scheme to steal money in business deals by overcharging for the services of a private courier company.

Ellen Barry and Andrew Roth contributed reporting.

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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 steady on "cliff" apprehension, Apple drops

NEW YORK (Reuters) - Stocks fell on Friday, with the Nasdaq weighed down by another drop in shares of Apple, and as the overhang of "fiscal cliff" negotiations kept buying to a premium.

Apple slid 4 percent to $508.75 after UBS cut its price target on the stock to $700 from $780. The most valuable U.S. company has seen its stock hit hard in the last three months, and it fell on Friday after a tepid reception for iPhone 5 in China.

The S&P Information Technology Index <.gspt> dropped 0.9 percent as Apple fell and Jabil Circuit Inc lost 6.2 percent to $17.38 after UBS cut its price target.

The possibility of a "fiscal cliff" deal not taking place until early 2013 is rising. The back-and-forth negotiations over the fiscal cliff in Washington have kept markets on hold in what would already be a quiet period for stocks.

"We're faced with uncertainty ... and that's going to continue now into January. It basically puts everybody on hold, and (you) just have the markets kind of thrash around," said Larry Abruzzi, senior equity trader at Cabrera Capital Markets Inc in Boston.

President Barack Obama and House of Representatives Speaker John Boehner held a "frank" meeting on Thursday at the White House to discuss how to avoid the tax hikes and spending cuts set to kick in early in 2013.

The S&P 500 dropped 0.6 percent on Thursday after six straight positive sessions. Investors are concerned that going over the cliff could tip the economy back into recession. While a deal is expected to ultimately be reached, a drawn-out debate - like the one seen over 2011's debt ceiling - can erode confidence.

"The markets are not being reactionary right now, though we lost ground yesterday," said Stephen Carl, head equity trader at the Williams Capital Group in New York.

"It doesn't look like anything has been resolved, or is leaning one way or another."

Still, expectations of an eventual agreement have helped the S&P 500 bounce back over the last month, and on Wednesday, the index hit its highest intraday level since late October. For the year, the S&P has advanced more than 12 percent.

The Dow Jones industrial average <.dji> slipped 24.09 points, or 0.18 percent, to 13,146.63. The Standard & Poor's 500 Index <.spx> lost 4.81 points, or 0.34 percent, to 1,414.64. The Nasdaq Composite Index <.ixic> fell 15.50 points, or 0.52 percent, to 2,976.66.

Best Buy Co Inc slid 15.5 percent to $11.93 after the electronics retailer agreed to extend the deadline for the company's founder to make a bid. Shares jumped as much as 19 percent on Thursday after initial reports of a bid this week from founder Richard Schulze.

Consumer prices fell in November for the first time in six months, indicating U.S. inflation pressures were muted. A separate report showed manufacturing grew at its swiftest pace in eight months in December.

Data out of China was encouraging, as Chinese manufacturing grew at its fastest pace in 14 months in December. The news was seen as helping U.S. materials companies, including U.S. Steel , which rose 6.3 percent to $23.73.

(Editing by Bernadette Baum and Jan Paschal)

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Avigdor Lieberman, Israeli Foreign Minister, Resigns

JERUSALEM — Facing indictment for breach of trust and fraud, Israel’s foreign minister, Avigdor Lieberman, resigned his post Friday afternoon amid mounting political pressure, upending the campaign landscape five weeks before national elections.

Mr. Lieberman, a powerful but polarizing figure, wrote on his Facebook page, “I know that I committed no crime,” but said he was stepping down so “I will be able to put an end to this matter swiftly and without delay and to clear my name completely.”

Mr. Lieberman, who is also a member of Parliament, indicated that he still hoped to compete in the Jan. 22 balloting, suggesting a possible plea bargain. The expected indictment, which prosecutors announced on Thursday, concerns a relatively minor offense compared with a broader case of money laundering and fraud that was dropped after an investigation stretching for more than 12 years.

“I believe that the citizens of the State of Israel are entitled to go to the polling stations after this matter has already been resolved,” Mr. Lieberman’s statement said. If a legal ruling could be made before the elections, “I might continue to serve the State of Israel and the citizens of Israel as part of a strong and united leadership that will cope with the security, political and economic challenges facing the State of Israel.”

Mr. Lieberman, 54, leads the secular, ultranationalist Yisrael Beiteinu party, which last month joined forces with Prime Minister Benjamin Netanyahu’s Likud Party. A populist immigrant from the former Soviet Union, he was widely considered as a potential successor to Mr. Netanyahu as leader of Israel’s right wing, though his hard line on the Palestinian question, among other issues, alienated many Western allies.

After the charges were announced, Mr. Lieberman told supporters that he had been hounded by corruption accusations since July 1996, when he served as a top aide to Mr. Netanyahu during his first term as prime minister. “Since then till today, not a day has passed without me being referred to as ‘a suspect,’ ‘being under investigation,’ ‘being an intelligence target,’ ” Mr. Lieberman said. “This has been one long and rolling case, receiving a different title every now and then.”

The conduct for which Mr. Lieberman will face indictment stems from an investigation into other allegations. He is accused of promoting Israel’s former ambassador to Belarus for another post after the ambassador gave him confidential information regarding an Israeli police investigation into Mr. Lieberman’s activities.

But Mr. Lieberman will not face charges on the underlying, more serious case, in which he was suspected of receiving millions of dollars from international tycoons with business interests in Israel through companies formally led by family members or associates.

Israel’s attorney general, Yehuda Weinstein, said Thursday in a report announcing his decision that he could not adequately prove a link between Mr. Lieberman and the money, though he said, “The suspicions against Lieberman’s series of intricate and intertwined, underhanded actions cannot be ruled out.”

Born in Moldova, Mr. Lieberman enjoys wide support among Israel’s one million immigrants from the former Soviet Union. He lives in a West Bank settlement considered illegal under international law, and he is perhaps the government’s harshest critic of President Mahmoud Abbas of the Palestinian Authority, having called for his ouster and denounced as “diplomatic terrorism” his recent bid for upgraded Palestinian status at the United Nations.

Polls have consistently shown that Mr. Lieberman’s joint ticket with Mr. Netanyahu, known here as Likud Beiteinu, is expected to receive up to 40 of the 120 seats in Israel’s next Parliament, by far the largest bloc. The merger was seen as crowning him a top contender to eventually follow Mr. Netanyahu as prime minister.

Opposition leaders, who on Thursday had called for Mr. Lieberman’s resignation, were swift to embrace it on Friday, but not without adding jabs.

Zahava Gal-On, chairwoman of the left-wing Meretz party, said Mr. Lieberman had “spared himself ignobility and disgrace” by stepping down, according to the Web site of Channel 2 News. Shelly Yacimovich, chairwoman of the Labor Party, said he had “severely undermined the rule of law and damaged the public’s faith in its elected officials and democracy.”

Tzipi Livni, a former foreign minister who now heads the new Hatnua Party, issued a more moderate statement, saying: “Avigdor Lieberman performed the right and necessary action. We hope he will receive a swift legal proceeding.”

Mr. Netanyahu had no immediate comment on Mr. Lieberman’s resignation Friday, but on Thursday had offered only support. “I believe in Israel’s legal system and respect it,” the prime minister said in a statement. “The right that it grants any Israeli citizen to defend himself also extends to Minister Lieberman, and I hope for him that he’ll be able to prove that he’s also innocent regarding the only case that remains.”

Under Israeli law, when a cabinet minister resigns, the prime minister becomes “custodian” of his portfolio, and Mr. Netanyahu is expected to handle foreign affairs himself at least until after the elections.

Jonathan Rosen contributed reporting.

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Home invasion victim gets help over Xbox headset

NORTH APOLLO, Pa. (AP) — Police say a Pennsylvania man used his Xbox headphones to call for help after being bound with duct tape and menaced with a gun during a home invasion.

Investigators say the 22-year-old suburban Pittsburgh man was playing video games in an upstairs bedroom when he heard his front door open. The man initially thought it was a family member but saw an armed man wearing a ski mask when he looked downstairs.

Authorities say the intruder bound Derick Shaffer and led him around the North Apollo home to locate valuables, then fled in Shaffer’s car. Shaffer reached a friend over his Xbox Live headset and had him call police.

The missing car was located about an hour later. Police questioned three people but are still trying to identify a suspect.

Gaming News Headlines – Yahoo! News

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Charles and Camilla's Royal Christmas Card Revealed

By Stephen M. Silverman

12/14/2012 at 11:35 AM EST

Prince Charles and the Duchess of Cornwall, on their Christmas card

Danny Martindale/WireImage

Why shouldn't Prince Charles and the Duchess of Cornwall be smiling?

It's been a year filled with happy news: the Queen's Jubilee, a baby on the way for the Duke and Duchess of Cambridge, even Prince Harry was revealed as a popular party guy – yet responsible enough to serve his country proudly.

And so, the couple's official Christmas card shows the two of them looking their merriest in a shot taken by photographer Danny Martindale while the royals were on board the Spirit of Chartwell during the Thames Diamond Jubilee Pageant on June 3, reports the Telegraph.

As for their outfits, Charles is sporting his Royal Navy admiral's ceremonial day dress uniform, while Camilla is donning an Anna Valentine coat and dress with a hat by Philip Treacy.

Not seen in the photo, although also in attendance at the ceremony: the Queen, the Duke of Edinburgh, the Duke and Duchess of Cambridge and Prince Harry.

And the message inside? "Wishing you a very Happy Christmas and New Year."

Back at you, folks!

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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..