Starting today there is a new version of General Assistance Medical Care, a two-tier system of care for very poor childless adults in Minnesota. In Minneapolis-St. Paul, GAMC patients will be able to sign up for comprehensive care at one of four hospitals that signed on to a healthcare compromise negotiated by Gov. Tim Pawlenty and legislators. But for thousands of others who live outside the metro area, choices for medical care are: Get help at his local hospital emergency room, look for clinics willing to give free care, or commute to the Twin Cities, the Minneapolis Star Tribune reports.