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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Royce Hall's quest for a big-sounding piano ends on a high note

Hours before showtime at UCLA's Royce Hall, Teri Meredyth leaned into a new Steinway & Sons concert grand piano.

Behind her, stagehands hammered together a stage extension. In front, workers shoved into place wooden panels for a backdrop. Stage left, an electrician shouted to a colleague aiming spotlights.

Meredyth, the hall's longtime piano technician, pounded the keys of the 9-foot-long grand, listening for off-kilter harmonics. She tweaked tuning pins and pricked felt hammers with a needle to soften them and thus warm the tone that would be produced when they hit the strings.

Amid the commotion, Meredyth struggled to hear the notes.

"I want the pianist to really enjoy what they're playing," she said. "If the piano is not helping them or something is going out of tune or the voicing is uneven, they get worried and don't have their best performance."

Getting a new piano — even a brilliant Steinway — performance-ready takes time.

Meredyth was tuning and voicing the piano for the third time in two days. That evening, Jeffrey Kahane, music director of the Los Angeles Chamber Orchestra, would perform the kinetic piano solo in George Gershwin's "Rhapsody in Blue."

Kahane had helped select the concert grand. He had performed on it in October, playing Ravel's jazz-infused Piano Concerto in G. Gershwin's original jazz band arrangement of "Rhapsody" would be an even bigger test of the piano the Royce Hall crew calls Sapphire.

Royce Hall began its quest for a big-sounding piano in 2010. Its first and only choice was a Steinway, a make dating to 1853 favored by such immortals as Gershwin, Sergei Rachmaninoff and Duke Ellington.

For many years, Royce Hall had relied upon Steinways its staff had affectionately named Diamond, Silver and Ruby. When the hall closed for renovation after the 1994 Northridge earthquake, the school sold Diamond and Silver, and kept Ruby, a workhorse built in 1983, for jazz and solo work.

For classical concerts with elite performers, the 1,800-seat Royce Hall rented Steinways. Eventually, the hall realized that having its own showcase piano could entice more great artists to perform there.

In September 2011, when Kristy Edmunds arrived as the executive and artistic director of the hall's performing arts series, selecting a Steinway was at the top of her to-do list. A grant and donations would cover the $128,000 cost.

She enlisted four experts, including Kahane and Meredyth. They met that November at the Steinway plant in Long Island City, N.Y.

Meredyth and a Steinway representative in Los Angeles had told factory workers what Royce Hall's lively acoustics demanded: a piano with great tone and depth, color, projection and what musicians call "sustain," which refers to how long the tone keeps sounding once a key has been played. Longer is better.

It takes 140 workers about a year to assemble a piano from rock maple, Sitka and white spruce, sugar pine, mahogany, birch and poplar. The results leave abundant room for chance. Every Steinway's sound is unique.

Steinway assembly workers detected the qualities that would best suit Royce Hall in the piano that bore factory serial number 590993 on the cast-iron plate above the keyboard. They placed it first in a line of half a dozen Model D concert grands inside the factory selection room.

The pianos looked like giant ravens, each with a raised wing. Kahane moved from bench to bench, playing the opening bars of Franz Schubert's virtuosic Sonata in B-flat major. The work is by turns turbulent and dreamy, and he wanted to hear and feel how each piano handled the subtle gradations of touch it demanded.

Piano No. 590993, in particular, had a lively response to his fingers and produced a rich, deep, clear tone. Kahane kept returning to it, impressed by its range of nuance and color, its ability to express passages from soft and tender to rip-roaring. "It was love at first sound," he said.

Soon after, Steinway factory workers tuned the concert grand and removed the legs and pedals. They sealed the cabinet in a foil bag, encased the bag in cardboard, placed the pieces in a wooden crate and loaded them onto an 18-wheeler to begin the cross-country journey to the piano's new home.

In October, UCLA threw a dinner party for Sapphire on the Royce stage. One hundred guests paid as much as $25,000 to dine on pumpkin-carrot soup and salmon; the proceeds will be used to commission work from emerging musicians.

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Letter From Washington: U.S. Fiscal Deal Unlikely Without Compromise

WASHINGTON — As many Republicans reject higher tax rates for wealthier Americans, Newt Gingrich, the former speaker of the U.S. House of Representatives, urges them to continue to resist, claiming that the economic boom of the 1990s and the resulting budget surplus were due to his leadership in Congress and not to President Bill Clinton’s early tax increases.

All economic indicators were heading downward before he became speaker, Mr. Gingrich said on the NBC television show “Meet the Press” on Dec. 9, and “virtually all the economic growth occurs after Republicans take control” of the House in 1995. The budget was balanced late in the decade because of the tax cut he engineered in 1997, he said.

To paraphrase the late Senator Daniel Patrick Moynihan, Mr. Gingrich is entitled to his opinion, but not to his own facts.

The arguments against higher taxes today and those used by Mr. Gingrich and his allies against the Clinton tax increase in 1993 are strikingly similar: They will destroy jobs and devastate economic growth, without cutting the deficit.

The facts: The Clinton tax increase on upper incomes, which brought the top rate to 39.6 percent, as President Barack Obama wants to do now, was enacted Aug. 6, 1993. Over the next 18 months, the U.S. economy grew at a rate of about 4 percent; unemployment dropped sharply, to 6 percent from 7.6 percent. The stock market rose moderately.

Deficits immediately began to narrow, shrinking to $22 billion in 1997 from $255 billion in 1993. In late 1997, a small tax cut that included a reduction in capital-gains levies and a child credit was passed, though the much larger tax increases enacted four years earlier were left largely untouched. The budget situation continued to improve, moving to surpluses over the next four years. Most economists credit this result to the climate of the decade, which Alan Greenspan, the former chairman of the Federal Reserve, and others said had been prompted by the 1993 legislation’s bolstering of consumer and investor confidence.

Now the Republican pursuit of lower marginal tax rates for the more affluent defies at least political reality. Polls show strong support for Mr. Obama’s position on the top rate.

Eliminating the George W. Bush-era tax cuts for upper-income Americans, taking the top rate to 39.6 percent, along with the accompanying changes on some deductions and exemptions, would raise about $600 billion in a decade.

During the presidential campaign, the Republican nominee, Mitt Romney, floated the notion of capping deductions at $50,000 a year; that would raise less than $500 billion if, as would seem certain, it excluded charitable contributions; there would be other controversies, and it would hit middle-class taxpayers.

There are significant other tax elements apart from the rates. Some compromises will be necessary on scheduled increases in levies on dividends and capital gains. On the estate tax, although it goes exclusively to the rich, some Senate Democrats, like Max Baucus of Montana and Mary Landrieu of Louisiana, favor a more generous break.

As the political tension mounts over the current fiscal deadlock — which, unless a deal is reached by Dec. 31, would increase taxes for everyone and force some draconian spending cuts — there will have to be trade-offs for any ultimate deficit-reduction deal. Congressional Republicans insist this will only be palatable if there are major cuts to entitlement programs, especially Medicare.

There are clear indications that the White House, despite the objections of some Democrats, would go along with significant changes, perhaps including a form of means testing for Medicare benefits, altering the cost-of-living adjustments for entitlements and taxes.

None of that will fly politically unless it is accompanied by significant revenue increases. Initially, Mr. Obama wanted $1.6 trillion over 10 years; he has pulled back to $1.4 trillion. If he gets an amount in excess of $1 trillion — which would require additional measures beyond ending the Bush-era tax cuts for the wealthy — a substantive deal on entitlements becomes more palatable.

Even if the current standoff over taxes and spending is resolved in the next two weeks, things are going to get messy early next year. Republicans are intent on using the need to increase the debt ceiling as leverage to force the White House to accept entitlement cuts; Mr. Obama is adamant that he won’t play Russian roulette with the debt ceiling again, a reference to last year’s market-rattling last-minute deal.

The only way to avoid that face-off is to devise some sort of enforcement mechanism before New Year’s Eve that would mandate action on entitlements and increased revenue next year. The test for the president in his second term is to get a deal that is market-credible, inspiring consumer and investor confidence.

The shorter-term test for the Republicans, as some operatives, like the former Mississippi governor Haley Barbour realize, is to move away from the issue of rates for the wealthy. One of the party’s liabilities in the 2012 elections was that it was seen as a protector of the privileged. Threatening a fiscal meltdown to protect lower tax rates for millionaires isn’t a corrective.

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Cisco hires bank to sell home wireless router unit: report

(Reuters) – Networking equipment company Cisco Systems Inc has hired Barclays to sell its Linksys home router unit, a report said on Sunday.

The business, which Cisco acquired for $ 500 million in 2003, will likely be valued for less because it has low margins, according to Bloomberg.

The sale is part of Cisco’s strategy to shed its consumer unit and focus on its software and technology services businesses.

Last year, Cisco axed its Flip camera business as part of this strategy.

(Reporting By Olivia Oran; Editing by Marguerita Choy)

Tech News Headlines – Yahoo! News

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Newtown Shooting Victims: Their Photos, Their Lives

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

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Experts: No link between Asperger's, violence

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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AP Writer Matt Apuzzo contributed to this report.

___

Online:

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

Read More..

Innovative housing for the homeless being built in downtown L.A.

The Skid Row Housing Trust has spent decades revitalizing abandoned buildings and hotels in downtown Los Angeles' most destitute neighborhood to serve as shelter for the city's chronically homeless.

But for its latest housing project, the trust abandoned its usual technique for a seemingly elementary construction concept. A 102-unit, $20.5-million complex is being built by stacking pre-outfitted apartments atop one another in a Lego-like fashion, limiting construction costs and fast-forwarding the project timeline. It is believed to be the first multi-tenant residential building in the nation to be constructed this way.

Like all of the Skid Row Housing Trust's 24 homes for the homeless, the sleek and distinctive Star Apartments are meticulously styled to look nothing like typical low-income housing.

The project, designed by award-winning architect Michael Maltzan, will include basketball courts, art centers, community gardens and hundreds of feet of green space. The stacking of apartment units began last week, and the bulk of the construction should be done by mid-January.

"What we're trying to create is something that feels like a microcosm of the city itself," said Maltzan, who has designed two other apartment complexes for the homeless in partnership with the trust.

Unlike dark, drafty and dreary low-income housing, where residents reside in monochromatic buildings, Maltzan's project, he said, infuses color and community with a layout and amenities that force residents to interact. That sense of community, housing trust officials believe, is paramount to rehabilitating the chronically homeless.

Because the pre-fabricated construction method is typically used for single-family homes, planners had to work with officials to clarify regulations and standards for shipping in the pre-constructed apartments, which the architect characterized as a tedious and at times frustrating process.

"The hope is that we've created a replicable pathway for similar projects," Maltzan said last week, as he watched a towering blue crane lift a pre-fabricated apartment unit onto a building platform. "When people look at this building, what they see is a vision of the future."

The Star Apartments will house up to 100 formerly homeless, with an emphasis on residents who are repeat patients at area emergency rooms or who have never received needed treatment for chronic medical conditions, said Mike Alvidrez, executive director of the Skid Row Housing Trust.

Residents will pay 30% of their monthly job or government assistance income as rent but are not required to seek on-site medical treatment, psychiatric counseling, drug or alcohol treatment or therapy as a condition of residency.

"The thought is, how do we help people make the choice that is best for them," said Alvidrez, who stressed the trust's Housing First model — a philosophy that has caught fire nationwide. Alvidrez said the first step to helping someone recover from a chronic drug or alcohol problem is to give them a home and sense of community.

"We're not going to build our way out of homelessness," Alvidrez said. While the housing trust's buildings are now home to more than 1,500 formerly homeless people, some estimates say as many as 51,000 people remain homeless in L.A. County.

The goal of the apartments is to fully rehabilitate residents through on-site social services, community space and professional development. While many eventually leave the housing trust's buildings and move into other homes, if they keep paying rent they're free to stay as long as they'd like. Lawrence Horn, 62, said he spent years on the streets of Los Angeles, afraid that his adult daughter might run into a destitute, shabby and drugged-out version of him while she was out on the town with her friends.

But a confident and polished Horn, in a crisp black shirt and suit, stood behind a lectern in front of about 50 people in the Last Bookstore on Tuesday and captivated them with a frank, 20-minute narrative of his life before and after moving into permanent housing offered by the trust.

Two years ago Horn moved off the streets and into the Carver Hotel, a circular structure designed by Maltzan next to the 10 Freeway. For the last year, he has been learning to become a spokesman for the trust through its resident ambassador program.

"I felt inferior, I felt less than," Horn said of his time living on the street. But now, he said, "my story is no longer a doom-and-gloom story."

wesley.lowrey@latimes.com

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Voters in Egypt Cast Ballots on Draft Constitution

Lynsey Addario for The New York Times

A polling site in Cairo on Saturday. Lines were long as a referendum on an Islamist-backed charter got off to an orderly start. More Photos »

CAIRO — Egyptians voted peacefully and in large numbers on Saturday in a referendum on an Islamist-backed draft constitution, hoping that the results would end three weeks of violence, division and distrust between the Islamists and their opponents over the ground rules of Egypt’s promised democracy.

Not long after polls closed at 11 p.m., the main Islamist group aligned with President Mohamed Morsi predicted a big win for ratification with a higher than expected turnout. The group, the Muslim Brotherhood, said that after counts from about 86 percent of the stations that voted Saturday, the first of two days of voting, ballots were running 59 percent in favor of the proposed constitution.

The opposition strongholds of Cairo and Alexandria, however, were still being counted.

A spokesman for the main coalition opposing the charter charged systematic violation of voting rules, but its leaders put off a final statement.

Regardless of the results, the unexpectedly heavy turnout and orderly balloting was yet another turning point for Egypt’s nearly two-year-old revolution. After three weeks of violence and threats of a boycott, voters appeared for the moment to pull back from the brink of civil discord and reaffirm their trust in the ballot box, spending hours in long lines to vote in the sixth national election since the ouster of Hosni Mubarak 22 months ago.

It remained to be seen if the losing side would accept the results, or how long the peace might last. Many who voted yes said they were doing so to end the chaos of the transition rather than to endorse the text of the charter. But the crowded polling places suggested a turn toward stability, if not necessarily the liberal outcome some revolutionaries had hoped for. Despite opposition warnings of chaos, the streets of the capital were free of major protests for the first time in weeks.

And if the constitution is approved by the margins his supporters predict, the smooth vote could fortify Mr. Morsi’s power and legitimacy.

Military officers guarded polling places, and there were few reports of violence. Egyptian state media reported nine injuries in clashes around the Nile Delta town of Dakahleya, and that unknown assailants threw Molotov cocktails near the headquarters of a liberal party that had been part of the opposition under Mr. Mubarak.

As they waited in line to vote, neighbors continued to spar over the contentious process that produced the charter. Some said that it had been unfairly steamrolled by Egypt’s new Islamist leaders over the objections of other parties and the Coptic Christian Church, and that as a result the new charter failed to protect fundamental rights.

Others blamed the Islamists’ opponents for refusing to negotiate, in an effort to undermine democracy because they could not win at the ballot box. Many expressed discontent with political leaders on both sides.

“Neither group can accept its opposition,” said Ahmed Ibrahim, 40, a government clerk waiting to vote in a middle-class neighborhood in the Nasr City area of Cairo. Whatever the outcome, he said, “one group in their hearts will feel wronged, and the other group will gloat over their victory, and so the wounds will remain.”

The referendum once promised to be a day when Egyptians realized the visions of democracy, pluralism and national unity that defined the 18-day revolt against Mr. Mubarak. But then came nearly two years of chaotic political transition in which Islamists, liberals, leftists, the military and the courts all jockeyed for power over an ever-shifting timetable.

The document that Egyptians voted on was a rushed revision of the old Mubarak charter, pushed through an Islamist-dominated assembly in an all-night session, after Christian and secular representatives quit in protest. Many international experts faulted the charter as a missed opportunity, stuffed with broad statements about Egyptian identity but riddled with loopholes regarding the protection of rights.

Worse still, for many, was the polarizing endgame the charter provoked. Leaders of the Muslim Brotherhood said more than 35 of its offices, including its Cairo headquarters, had been attacked and vandalized over the last three weeks. A night of street fighting between his Islamist supporters and their opponents killed at least 10 people.

Many voters waiting in line on Saturday said they rejected the exploitation of religion by both sides: the Islamists who sought to frame the debate as an argument over Islamic law, and opponents who accused Mr. Morsi and his Islamist allies of laying the groundwork for a theocracy.

Mayy El Sheikh and Mai Ayyad contributed reporting.

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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."

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

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

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