"It's the beginning of a new day in America," Sharon Phillips of Parkland Memorial Hospital said last week. Except that she also works in Texas, and that can be, well, complicated. Phillips, an executive vice president, was celebrating a milestone in health reform, the launch of online marketplaces. They offer private insurance for those with no coverage and often include federal subsidies to make it affordable. Parkland was eager to help folks sign up, given that about 50,000 uninsured patients may qualify. The catch is that many other customers will be left out in the cold: About 180,000 earn too little money to get public help, Phillips said.