Japan's next PM Abe must deliver on economy, cope with China


TOKYO (Reuters) - Japan's hawkish ex-premier Shinzo Abe will get a second chance to run the country after his conservative Liberal Democratic Party (LDP) surged to power in Sunday's election, but must swiftly move to bolster the sagging economy while managing strained ties with China.


Abe, whose party won by a landslide just three years after a crushing defeat, was expected on Monday to meet Natsuo Yamaguchi, the leader of the small New Komeito party, to cement their alliance and confirm economic steps to boost an economy now in its fourth recession since 2000.


The victory by the LDP, which had ruled Japan for most of the past 50 years before it was ousted in 2009, will usher in a government pledged to a tough stance in a territorial row with China, a pro-nuclear energy policy despite the 2011 Fukushima disaster and a potentially risky recipe for hyper-easy monetary policy and big fiscal spending to boost growth.


Projections by TV broadcasters showed that the LDP had won at least 291 seats in the 480-member lower house, while the New Komeito party took at least 29 seats.


That gives the two parties the two-thirds majority needed to overrule parliament's upper house in most matters, where they lack a majority and which can block bills. The "super majority" could help to break a policy deadlock that has plagued the world's third biggest economy since 2007.


Markets have already pushed the yen lower and share prices higher in anticipation of an LDP victory and Abe's economic stimulus. The two-thirds "super majority" could boost share prices and weaken the yen further.


Prime Minister Yoshihiko Noda's Democratic Party of Japan (DPJ) was crushed, forecast to win just about 56 seats - less than a fifth of its showing in 2009, when it swept to power promising to pay more heed to consumers than companies and pry control of policies from bureaucrats.


But voters deemed the pledges honored mostly in the breach and the party was hit by defections before the vote due to Noda's unpopular plan to raise the sales tax to curb public debt already more than twice the size of the economy.


"This was an overwhelming rejection of the DPJ," said Gerry Curtis, a professor at New York's Columbia University.


"Abe was smart to run the campaign saying 'It's the economy, stupid. His hawkish (security) views took second place to fiscal stimulus and getting a dovish Bank of Japan governor and getting the economy going. If he keeps that focus ... he has a chance of improving his standing."


Analyst Bruce Klingner of the Heritage Foundation think tank in Washington said the return of Abe and LDP was foremost a rejection of the DPJ, but "also reflects an embrace of conservative views" after recent years of strained relations with Japan's close neighbors.


"Chinese assertiveness and North Korean provocations nudged the public from its usual post-war complacency toward a new desire to stand up for Japanese sovereignty," he said.


The Japanese favor moving toward "a more normal nation status" and are not embracing resurgent militarism, added Klingner, a former CIA analyst.


Abe, expected to be voted in by parliament on December 26, will also have to prove he has learned from the mistakes of his first administration, plagued by scandals and charges of incompetence.


Voter distaste for both major parties has spawned a clutch of new parties including the Japan Restoration Party, founded by popular Osaka Mayor Toru Hashimoto, which took at least 52 seats, according to media projections.


But media estimates showed turnout at around 59 percent, which could match the previous post-war low.


LDP leader Abe, 58, who quit as premier in 2007 citing ill health, has been talking tough in a row with China over uninhabited isles in the East China Sea, although some experts say he may temper his hard line with pragmatism once in office.


The soft-spoken grandson of a prime minister, who will become Japan's seventh premier in six years, Abe also wants to loosen the limits of a 1947 pacifist constitution on the military, so Japan can play a bigger global security role.


President Barack Obama congratulated Abe and underlined U.S. interest in working with the longstanding American ally.


"The U.S-Japan Alliance serves as the cornerstone of peace and prosperity in the Asia-Pacific and I look forward to working closely with the next government and the people of Japan on a range of important bilateral, regional and global issues," he said in a statement.


The LDP, which promoted atomic energy during its decades-long reign, is expected to be friendly to nuclear utilities, although deep public concerns remain over safety.


Abe has called for "unlimited" monetary easing and big spending on public works to rescue the economy. Such policies, a centerpiece of the LDP's platform for decades, have been criticized by many as wasteful pork-barrel politics.


Many economists say that prescription for "Abenomics" could create temporary growth and enable the government to go ahead with a planned initial sales tax rise in 2014 to help curb a public debt now twice the size of gross domestic product.


But it looks unlikely to cure deeper ills or bring sustainable growth to Japan's ageing society, and risks triggering a market backlash if investors decide Japan has lost control of its finances.


(Additional reporting by Paul Eckert in Washington; Editing by Tomasz Janowski and Eric Walsh)



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Kate attends first public engagement since illness






LONDON: Prince William's pregnant wife Catherine on Sunday made her first public engagement since being hospitalised for severe morning sickness, presenting cyclist Bradley Wiggins with the prestigious BBC Sports Personality of the Year award.

Kate, 30, presented the main award and a lifetime achievement honour to London Olympic Games organiser Seb Coe at a ceremony in the British capital.

The Duchess of Cambridge was admitted to hospital on December 3, a development which prompted the palace to announce that she was in the very early stages of pregnancy.

She left the London hospital after three nights and had not been seen in public since.

The duchess took to the stage in a full-length green dress to present Coe with his award, sharing a private conversation with the former Olympian.

She was also quiet as superstar footballer David Beckham announced Wiggins as the winner, but handed over the famous trophy to the Tour de France and Olympic time-trial champion.

Stars from the London Olympics dominated the award shortlist, and Kate was understood to be keen to attend to continue her involvement in the summer Games, during which she, her husband and brother-in-law Prince Harry were official ambassadors.

"She will not stay for the whole thing but she really wanted to be there," a royal source told AFP.

The baby is the first for the royal couple, who married in a lavish ceremony in April 2011, and will be heir to Queen Elizabeth II's throne after William's father Prince Charles and William himself.

The news about the royal baby was overshadowed, however, by the apparent suicide of a nurse working at Kate's hospital after she took a hoax call from two Australian radio presenters that led to details of the duchess's condition being made public.

- AFP/fa



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Report gives details of Fasih-Bhatkal partnership

NEW DELHI: Almost two months after Indian Mujahideen founder member Fasih Mehmood was brought to India from Saudi Arabia, TOI has exclusively accessed his interrogation report which gives a detailed account of IM's foundation, his first interaction with IM boss Zarar Ahmad Siddibappa alias Yasin Bhatkal, Riyaz and Iqbal Bhatkal.

The interrogation report clearly states that when Fasih was doing his engineering from Bhatkal (Karnataka), he came close to Yasin Bhatkal. His father Firoz Ahmad did not approve of his friendship with Bhatkal. The report further gives names of some people who were regular in his college apart from some new names, which are being looked for apart from his meeting with IM's media wing chief Abdus Subhan Qureshi.

Fasih was deported to India in October in what the government claimed was a 'big catch'. He was mainly wanted for the Meer Vihar factory arms haul and Chinnaswamy stadium bomb blast, but was alleged to have worked as an important financier for IM.

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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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School Shooting Victims Were Shot Multiple Times













The gunman who massacred 20 children in a Connecticut elementary school riddled them with bullets, shooting some of them as many as 11 times, the medical examiner said today.


"I've been at this for a third of a century so my sensibilities may not be the that of the average man, but it's probably the worst I've ever seen," said Chief Medical Examiner H. Wayne Carver II, who has been a medical examiner for 36 years.


A team of 14 medical technicians worked through the night to complete the grisly job of identifying the children killed by Adam Lanza, 20, in the Sandy Hook Elementary School massacre so their names could be released today.


Several weapons were found in the school, including a semi-automatic rifle.


"All the wounds that I know of at this point were caused by the long weapon," Carver said, and many were shot at close range.


CLICK HERE for full coverage of the tragedy at the elementary school.


"I believe many of them were hit more than once," and he said the wounds were "all over" the children's bodies.


"I only did seven of the autopsies. The victims I had ranged from 3 to 11 wounds a piece," Carver said.


The names of the children slain Friday in the Newtown, Conn., school were released today.


To carry out the identifications, Carver said they "did not bring the families and the bodies into contact." He said the identifications were made through photographs of the children's faces. "It's easier on the families," he said.


Additional work is needed to complete the autopsies and identifications of the seven adults slain in Lanza's killing spree.






Emmanuel Dunand/AFP/Getty Images











Newtown Teacher Kept 1st Graders Calm During Massacre Watch Video











Newtown School Shooting: What to Tell Your Kids Watch Video





Fresh details of the massacre emerged including the fact that all of the young victims were first graders in two rooms.


Based on the Sandy Hook school directory, all the kids killed were in the first grade and were in two classrooms.


In one class, 15 of the 16 students listed were killed. In the other class, five of the 16 students died along with their teacher Victoria Soto. Also, nine of the deceased students have siblings in the school.


At a nearby firehouse that has become a center for the town a makeshift memorial and vigil has emerged under a sign that reads "Sandy Hook School." People have left flowers, candles, signs that read "Rest in Peace" and "God Bless Sandy Hook Elementary," as well as a cross made of blue flowers and a wreath of teddy bears


With the tally of Lanza's carnage complete, authorities and the grieving people of Newtown, Conn., are left to wonder why he turned the elementary school in this quaint New England town into a slaughter house.


Connecticut State Police Lt. Paul Vance said the investigation "did produce some very good evidence" about motive, but he would not go into further detail.


He indicated the evidence came from the shooting scene at the school as well as at the home where Lanza's mother, Nancy, was slain.


Also key will be the lone person shot by Lanza who wasn't killed. The female teacher has not been publicly identified.


"She is doing fine," Vance said at a news conference today. "She has been treated and she'll be instrumental in this investigation."


Vance said it appears that reports of an altercation involving Lanza at the school in the days before the mass slaying are not checking out.


Vance said that Lanza forced his way into the school, but did not say how.


Evidence emerged today that Lanza's rampage began in the office of school principal Dawn Hochsprung while the school intercom was on. It's not clear whether it was turned on to alert the school or whether it was on for morning announcements, but the principal's screams and the cries of children heard throughout the school gave teachers time to take precautions to protect their children.


Hochsprung was among those killed in the Friday morning killing spree.


READ: Connecticut Shooter Adam Lanza: 'Obviously Not Well'


Authorities have fanned out to New Jersey, Connecticut and Massachusetts to interview Lanza's relatives, ABC News has learned.


According to sources, Lanza shot his mother in the face, then left his house armed with at least two semi-automatic handguns, a Glock and a Sig Sauer, and a semi-automatic rifle. He was also wearing a bulletproof vest.






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Violence flares in Cairo as Egyptians vote


CAIRO (Reuters) - Islamists attacked the offices of an Egyptian opposition party newspaper on Saturday, security sources said, as people voted on a new constitution intended to pull the country out of a growing political crisis.


The newspaper of the Wafd party in Cairo was targeted with petrol bombs and birdshot, the sources said, in the latest of a series of violent incidents surrounding a divisive referendum designed to pave the way to national elections next year.


The attack came as officials began counting votes after polling stations closed at 11 p.m. (1600 ET).


Official results will not come until after a second round of voting in remaining areas of the country next Saturday, but conflicting claims were already emerging from the rival camps.


A spokesman for the opposition National Salvation Front said it had indications that 60-65 percent of voters in Cairo and other cities had rejected the new constitution, while President Mohamed Mursi's Muslim Brotherhood allies said that after 1 million votes had been counted, 72.5 percent were in favor.


Mostafa Shafik, managing editor at Wafd's newspaper, which is located next to the party headquarters, said his offices had been damaged.


"The attackers used Molotov cocktails to enter, which left minor areas burned," he said.


A Reuters photographer saw a dozen or so cars damaged inside the Wafd headquarters' grounds, their windows broken. Glass was also broken in the headquarters, but he saw no immediate signs of fire damage. Two people appeared to have been injured.


Wafd blamed followers of Hazem Abu Ismail, a Salafist preacher, for the attack, but he used his Facebook page to deny involvement.


Violence in Cairo and other cities has marred the run-up to the referendum. Several party buildings belonging to the Muslim Brotherhood's Freedom and Justice party have been burned in protests.


Rival factions armed with clubs, knives and swords fought in the streets of Alexandria on Friday. Opposition supporters trapped a Muslim preacher inside his mosque after he backed a "yes" vote in favor of the constitution.


ANGRY DEMONSTRATIONS


President Mursi provoked angry demonstrations when he issued a decree last month expanding his powers and then fast-tracked the draft constitution through an assembly dominated by his Muslim Brotherhood group and its allies. At least eight people were killed in clashes last week outside the presidential palace.


His liberal, secular and Christian opponents say the constitution is too Islamist and tramples on minority rights. Mursi's supporters say the charter is needed if progress is to be made towards democracy nearly two years after the fall of military-backed strongman Hosni Mubarak.


"The sheikhs (preachers) told us to say 'yes' and I have read the constitution and I liked it," said 53-year-old Adel Imam as he queued to vote in Cairo on Saturday. "The country will move on."


Turnout was high enough for voting to be extended by four hours in Cairo and some other cities.


In order to pass, the constitution must be approved by more than 50 percent of voters who cast ballots. A little more than half of Egypt's electorate of 51 million are eligible to vote in the first round in Cairo and other cities.


Rights groups reported some abuses, such as polling stations opening late, officials telling people to vote "yes", bribery and intimidation.


But Gamal Eid, head of the Arab Network for Human Rights Information, which is monitoring the vote, said nothing reported so far was serious enough to invalidate the referendum.


TRANSITION


Christians, making up about 10 percent of Egypt's 83 million people and who have long complained of discrimination, were among those waiting at a polling station in Alexandria to oppose the basic law. They fear Islamists, long repressed by Mubarak, will restrict social and other freedoms.


"I voted 'no' to the constitution out of patriotic duty," said Michael Nour, a 45-year-old Christian teacher in Alexandria. "The constitution does not represent all Egyptians."


Howaida Abdel Azeem, a post office employee, said: "I said 'yes' because I want the destruction the country is living through to be over and the crisis to pass."


Islamists are counting on their disciplined ranks of supporters and the many Egyptians who may fall into line in the hope of ending turmoil that has hammered the economy and sent Egypt's pound to eight-year lows against the dollar.


Mursi was among the early voters after polls opened at 8 a.m. (0600 GMT). He was shown on television casting his ballot shielded by a screen and then dipping his finger in ink - a measure to prevent people voting twice.


The second round will be held in other regions on December 22 because there are not enough judges willing to monitor all polling stations after some said they would boycott the vote.


Egyptians are being asked to accept or reject a constitution that must be in place before a parliamentary election can be held next year to replace an Islamist-led parliament dissolved in June. Many hope this will lead Egypt towards stability.


If the constitution is voted down, a new assembly will have to be formed to draft a revised version, a process that could take up to nine months.


The army has deployed about 120,000 troops and 6,000 tanks and armoured vehicles to protect polling stations and other government buildings. While the military backed Mubarak and his predecessors, it has not intervened in the present crisis.


(Writing by Edmund Blair and Giles Elgood; Editing by Tom Pfeiffer)



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Counting under way in Egyptian referendum






CAIRO: Counting was under way early Sunday after a first-round referendum on a divisive new constitution pushed through by President Mohamed Morsi and his Islamist allies despite weeks of opposition protests.

Polling stations in half the country, including the biggest cities of Cairo and Alexandria, were tallying the results from Saturday's voting.

The second round of the referendum is to be held next Saturday, after which the official result is to be given.

Morsi's Muslim Brotherhood and main media outlets said that, based on very early unofficial figures, it appeared that the polling was trending towards 70 percent support for the draft charter.

But the opposition disputed that, saying its preliminary figures suggested that 66 percent of the voters had rejected the proposed constitution. It claimed the Muslim Brotherhood had sought to "rig" the vote.

If those contradictory positions are maintained, Egypt's turmoil of the past three weeks over the draft constitution will not subside.

Violent clashes claimed eight lives on December 5 amid a highly polarised political climate.

Late Saturday, riot police fired tear gas to disperse dozens of hardline Islamists who attacked the central Cairo headquarters of the opposition liberal Wafd Party with fireworks and stones, officers at the scene told AFP.

On Friday, clashes between stone-throwing and sword-wielding Islamists and opposition supporters erupted in Egypt's second city of Alexandria, injuring 23 people according to the official MENA news agency.

To ensure security, 120,000 troops were deployed to reinforce 130,000 police.

Voting was being staggered, with half the country casting their ballots on Saturday and the other half a week later.

The Muslim Brotherhood has thrown its formidable organisational machine behind a campaign in favour of the draft constitution.

The proposed charter "offers rights and stability," said one Cairo voter who backed it, Kassem Abdallah.

It will help Egypt "return to normal", agreed another, Ibrahim Mahmoud, a teacher.

But many opposition voters were especially hostile toward the Brotherhood, which the Front believes wants to usher in strict Islamic sharia laws.

Abbas Abdelaziz, a 57-year-old accountant, said he voted against the charter "because I hate the Muslim Brotherhood. It's very simple. They are liars."

Sally Rafid, a 28-year-old Christian, said: "There are many things in the constitution people don't agree on, and it's not just the articles on religion."

International watchdogs, the UN human rights chief, the United States and the European Union have expressed reservations about the draft because of loopholes that could be used to weaken human rights, including those of women, and the independence of the judiciary.

Analysts said it was likely - but not certain - that the draft constitution would be adopted.

Whatever the outcome, "lasting damage to the civility of Egyptian politics will be the main outcome of the current path Morsi has set Egypt on," one analyst, Issandr El Amrani, wrote for his think tank, the European Council on Foreign Relations.

"If the 'no' vote wins, the Morsi presidency will have been fully discredited and the pressure for his resignation will only increase," he said. "If 'yes' wins, the protest movement is unlikely to die down, (and) may radicalise."

- AFP/de



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Govt plans own channel, real autonomy for DD

NEW DELHI: The information and broadcasting (I&B) ministry has asked regulator Trai for a review of the policy which disallows government ownership of television channels. This letter to the regulator is seen as a precursor to the Centre launching a TV channel of its own.

On November 30, I&B secretary Uday Kumar Varma wrote to Trai chairman Rahul Khullar asking him "to kindly provide your recommendations as to whether the following may be allowed" in broadcasting: central and state government ministries and departments, state-owned companies, undertakings and joint ventures.

Varma cited the instances of the governments of Gujarat, Punjab, Andhra Pradesh and the Union HRD ministry seeking permission to operate and distribute their TV channels which the I&B ministry has turned down because the current policy doesn't allow government presence in broadcasting.

Sources in the ministry said Doordarshan was allowed because it was ostensibly run by an autonomous body, Prasar Bharati. They also said that it was a question of time before Prasar Bharati is likely to be asked to raise and manage its own finances and that would automatically lead to the public broadcaster asserting its autonomy.

It's in this context that the government's letter seeking Trai's views on government presence in broadcasting acquires significance. Incidentally, Doordarshan enjoys 92% coverage of the country through its terrestrial network with a viewership of about 2.5 crore people.

Not just TV channels, the government is also keen on having a presence in print and radio too. There is urgency to the move in view of elections in 2014 when the government having its own media would be undoubtedly helpful.

While the Punjab government sought permission for its own TV channel, the Gujarat government and HRD ministry sought the I&B ministry's nod to set up educational channels on their own DTH platforms.

90% of I&B funds spent on Prasar Bharati

Sources said that the I&B ministry was looking to recast Prasar Bharati as a financially autonomous public service broadcaster like the BBC with independent sources of funding like licence fees, commercial programming and ads.

At present 90% of the ministry's fund is spent on funding Prasar Bharati's operations. I&B minister Manish Tewari is said to have discussed the issue with senior memeber of the government. "Why should there be a veil of hypocrisy in running one's own channel or paper? If there are 800 TV channels, allowing 30 more will only be a drop in the ocean. If there are 3,000 radio stations, there can be space for 30 more, and the same is true for papers," the sources said.

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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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20 Children Killed at Conn. Grade School, 7 Adults













Twenty children died today when a heavily armed man invaded a Newtown, Conn., elementary school and sprayed staff and students with bullets.


The gunman, identified as Adam Lanza, 20, was found dead in the school.


Lt. Paul Vance said 18 children died in the school and two more died later in a hospital. Six adults were also slain, bringing the total to 26.


In addition to the casualties at the school, Lanza's mother Nancy Lanza was killed in her home, federal and state sources told ABC News.


According to sources, Lanza shot his mother in the face, then left his house armed with at least two semi automatic handguns, a Glock and a Sig Sauer, and a semi automatic rifle. He was also wearing a bullet proof vest.


Lanza drove to Sandy Hook Elementary School and continued his rampage, killing 26 people, authorities said. He was found dead at the school. It appears that he died from what is believed to be a self inflicted gunshot wound. The rifle was found in his car.


In the early confusion surrounding the investigation, federal sources initially identified the suspect as Adam's older brother Ryan Lanza, 24. He is being questioned by police.


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"Evil visited this community today," Gov. Dan Malloy said at a news conference this evening.


First grade teacher Kaitlin Roig, 29, locked her 14 students in a class bathroom and listened to "tons of shooting" until police came to help.








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"It was horrific," Roig said. "I thought we were going to die."


She said that the terrified kids were saying, "I just want Christmas…I don't want to die. I just want to have Christmas."


A tearful President Obama said there's "not a parent in America who doesn't feel the overwhelming grief that I do."


The president had to pause to compose himself after saying these were "beautiful little kids between the ages of 5 and 10." As he continued with his statement, Obama wiped away tears from each eye.


He has ordered flags flown as half staff.


CLICK HERE for more photos from the scene.


The alert at the school ended when Vance announced, "The shooter is deceased inside the building. The public is not in danger."


The massacre prompted the town of Newtown to lock down all its schools and draw SWAT teams to the school, authorities said today. Authorities initially believed that there were two gunmen and were searching cars around the school, but authorities do not appear to be looking for another gunman.


It is the second worst mass shooting in U.S. history, exceeded only by the Virginia Tech shooting in 2007 when 32 were killed before the shooter turned the gun on himself. Today's carnage exceeds the 1999 Columbine High School shooting in which 13 died and 24 were injured.


The Newtown shooting comes three days after masked gunman Jacob Roberts opened fire in a busy Oregon mall, killing two before turning the gun on himself.


Today's shooting occurred at the Sandy Hook Elementary School, which includes 450 students in grades K-4. The town is located about 12 miles east of Danbury.


State Police received the first 911 call at 9:41 a.m. and immediately began sending emergency units from the western part of the state. Initial 911 calls stated that multiple students were trapped in a classroom, possibly with a gunman, according to a Connecticut State Police source.


Lt. Paul Vance said that on-duty and off-duty officers swarmed to the school and quickly checked "every door, every crack, every crevice" in the building looking for the gunman and evacuating children.


A photo from the scene shows a line of distressed children being led out of the school.


Three patients have been taken to Danbury Hospital, which is also on lockdown, according to the hospital's Facebook page.






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