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


TOKYO (Reuters) - Conservative ex-premier Shinzo Abe will get a second chance to lead Japan after his Liberal Democratic Party surged back to power in Sunday's election, but he must move swiftly to bolster a sagging economy and manage strained ties with China to avoid the fate of his short-lived predecessors.


Abe, whose party won by a landslide just three years after a crushing defeat, is due to meet the leader of its small ally on Monday 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 294 seats in the 480-member lower house, while its ally the New Komeito party took 31 seats.


That gives them a two-thirds majority needed to overrule parliament's upper house in most matters. Since 2007, successive governments have been hamstrung by a "twisted parliament" where ruling coalitions lacked control over the upper house, which could block most legislation.


While investors have already pushed the yen lower and share prices higher in anticipation of an LDP victory and Abe's economic stimulus, the "super majority" drove the yen to a 20-month low against the U.S. dollar as far as 84.48.


Japan's benchmark Nikkei opened up 1.6 pct on Monday, hitting a high of more than eight months.


Prime Minister Yoshihiko Noda's Democratic Party of Japan (DPJ) was crushed. It was forecast to win 57 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 felt the DPJ failed to live up to those pledges 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, which is 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. That sentiment was echoed in Japanese media.


"In a word, rather than a huge victory for the LDP, this election was a massive defeat for the Democrats," the Nikkei business daily said in an editorial.


Analyst Bruce Klingner of the Heritage Foundation think tank in Washington agreed, but said it "also reflects an embrace of conservative views" after strained relations with Japan's neighbors in recent years.


"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.


However, that did not mean the Japanese were embracing a return to militarism, added Klingner, a former CIA analyst.


LOW TURNOUT


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 54 seats according to media projections.


Media estimates also 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," he said in a statement.


Abe, who visited China first during his first term, said he would start off this time by going to Washington.


The LDP, which promoted nuclear energy during its decades-long reign, is expected to be friendly to power 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.


Jiji news agency said previous LDP Prime Minister Taro Aso, 72, could be tapped as finance minister and deputy premier. He launched massive economic stimulus packages to fight the impact of the 2008-2009 global financial crisis but was dogged by policy flipflops and gaffes.


Many economists say that prescription for "Abenomics" could create temporary growth that would allow the government to proceed with a planned initial sales tax rise in 2014 to help curb public debt.


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.


(Editing by Tomasz Janowski and Paul Tait)



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Body found in Singapore River






SINGAPORE: A man was found dead in the Singapore River along Clarke Quay early Sunday morning.

The Singapore Civil Defence Force (SCDF) said it received a call at about 1.30am.

Someone was spotted jumping into the river near Block A.

SCDF officers arrived about four minutes later and conducted a search around the area.

Diving at a depth of about 3 metres, rescuers retrieved the body of a man about three-and-a-half hours later.

He was pronounced dead at the scene.

Police are investigating the unnatural death.

- CNA/ir



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Haryana residents prefer khaps over courts: Report

CHANDIGARH: A survey carried out by a sub-committee constituted by Haryana Backward Class Commission (HBCC) to ascertain possibility of reservation for jats and other communities has found out that rustic Haryanvis have more faith in social panchayats than judicial courts and prefer to approach khaps for remedial measures.

During the survey conducted on 49,870 households in rural areas, it was found that 66.6% families from 16 different castes said they preferred approaching khap panchayats than opting for judicial remedies for seeking justice whenever disputes arise. The survey was tasked to ascertain khaps' influence in Haryana and was conducted by a sub-committee headed by K S Sangwan, a former HoD of department of sociology at Maharishi Dayanand University, Rohtak.

The research was one of the 12 social indicators used by the sub-committee for determining social, educational and economical backwardness of various castes and communities of Haryana. While this part of the report has come as a shot in the arm for khap leaders, who claim khap panchayat to be legitimate dispute disputes platform, they have very conveniently chosen to trash the rest of the report.

"This is the only portion where the commission could not manipulate. We cannot rely on any other recommendations made in the report,'' said Sube Singh Samain, a spokesperson of Sarvjat Khap Panchayat.

Khaps in Haryana have been inviting criticism from various sections of the society as well as Punjab and Haryana High court for their diktats on barring same-village marriages and inter-caste marriages, which has led to incidents of honor killings in the state.

"Bhaichara (brotherhood) concept still exists in rural Haryana. Khaps have played important role in solving common problems. Villagers feel that in courts only one party wins the case. But when it comes to khap panchayats, it is a win-win situation for both the parties,'' said Sangwan.

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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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Conn. Victim's Father Remembers 'Loving' Daughter


ht emilie parker wy 121215 wblog Emilie Parker: Sandy Hook Victim Would Have Comforted Classmates, Dad Says

(Image credit: Emilie Parker Fund/Facebook)


Emilie Parker, the little girl with the blond hair and bright blue eyes, would have been one of the first to comfort her classmates at Sandy Hook Elementary School, had a gunman’s bullets not claimed her life, her father said.


“My daughter Emilie would be one of the first ones to be standing and giving support to all the victims because that’s the kind of kid she is,” her father, Robbie Parker said as he fought back tears, telling the world about his “bright, creative and loving” daughter who was one of the 20 young victims in the Newtown, Conn., shooting.


“She always had something kind to say about anybody,” her father said.  ”We find comfort reflecting on the incredible person Emilie was and how many lives she was able to touch.”


Emilie, 6, was helping teach her younger sisters to read and make things, and she was the little girls would go to for comfort, he said.


“They looked up to her,” Parker said.


READ: Complete List of Sandy Hook Victims


Parker moved his wife and three daughters to Newtown eight months ago after accepting a job as  a physician’s assistant at Danbury Hospital. He said Emilie, his oldest daughter, seemed to have adjusted well to her new school, and he was very happy with the school, too.


“I love the people at the school. I love Emilie’s teacher and the classmates we were able to get to know,” he said.


ap shock newton shooting sandy hook lpl 121214 wblog Emilie Parker: Sandy Hook Victim Would Have Comforted Classmates, Dad Says

      (Image Credit: Alex von Kleydorff/AP Photo)


The family dealt with another tragic loss in October when Emilie lost her grandfather in an accident.


“[This] has been a topic that has been discussed in our family in the past couple of  months,” Parker said. “[My daughters ages 3 and 4] seem to get the idea that there’s somebody who they will miss very much.”


Emilie, a budding artist who carried her markers and pencils everywhere, paid tribute to her grandfather by slipping a special card she had drawn into his casket, Parker said.  It was something she frequently did to lift the spirits of others.


“I can’t count the number of times Emilie would find someone feeling sad or frustrated and would make people a card,” Parker said. “She was an exceptional artist.”


The girl who was remembered as “always willing to try new things, other than food” was learning Portuguese from her father, who speaks the language.


ht emilie parker 2 121215 wblog Emilie Parker: Sandy Hook Victim Would Have Comforted Classmates, Dad Says

(Image Credit: Emilie Parker Fund/Facebook)


On Friday morning, Emilie woke up before her father left for his job and exchanged a few sentences with him in the language.


“She told me good morning and asked how I was doing,” Parker said. “She said she loved me, I gave her a kiss and I was out the door.”


Parker found out about the shooting while on lockdown in Danbury Hospital and found a television for the latest news.


“I didn’t think it was that big of deal at first,” he said. “With the first reports coming in, it didn’t sound like it was going to be as tragic as it was. That’s kind of what it was like for us.”


CLICK HERE for full coverage of the Sandy Hook shooting.


Parker said he knows that God can’t take away free will and would have been unable to stop the Sandy Hook shooting. While gunman Adam Lanza used his free agency to take innocent lives, Parker said he plans to use his in a positive way.


“I’m not mad because I have my  [free] agency to use this event to do whatever I can to make sure my family and my wife and my daughters are taken care [of],” he said. “And if there’s anything I can do to help to anyone at any time at anywhere, I’m free to do that.”


ht emilie parker 3 121215 wblog Emilie Parker: Sandy Hook Victim Would Have Comforted Classmates, Dad Says

(Image credit: Emilie Parker Fund/Facebook)


Friday night, hours after he learned of his daughter’s death, Parker said he spoke at his church.


“I don’t know how to get through something like this. My wife and I don’t understand how to process all of this,” he said today. “We find strength in our religion and in our faith and in our family. ”


“It’s a horrific tragedy and I want everyone to know our hearts and prayers go out to them. This includes the family of the shooter. I can’t imagine how hard this experience must be for you and I want you to know our family … love and support goes out to you as well.”

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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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Police hunt man who threatened shooting at US mosque






LOS ANGELES: Police in California are looking for a man who reportedly walked into a California mosque saying he had a gun and threatened to kill everyone, a spokeswoman said Friday.

The man entered the Ibrahim Khalilullah Islamic Center in Fremont, south of San Francisco, during afternoon prayer Wednesday, said mosque leaders, urging official action to track down the man.

According to witnesses, a "white male in his thirties entered the IKI Center Mosque during prayer, and shouted that he had a gun and wanted to kill everyone. When confronted, the male left," said a police spokeswoman.

"We are a little worried because of the situation that happened in Oregon," said Fareed Wardak, a member of the center's board of directors, referring to a shooting in the western US state that left three dead on Tuesday.

"We don't want the same thing to happen," he told KTVU television, in comments made before Friday's shooting at an elementary school in the eastern state of Connecticut that killed 20 children and six adults.

The man left without taking out a gun. Fremont Police Department spokeswoman Geneva Bosques told AFP: "He never displayed a gun, kept his hands in his pockets. We are following up in an attempt to look at video surveillance."

The man possibly drove a 1990s gray Toyota Camry, and officers will be carrying out extra patrols looking for anything suspicious, KTVU reported.

"We do have surveillance cameras. We'll be getting pictures out of that system," said Wardak, adding: "We're not sure what kind of person" the man was.

"It's Christmas, people are going back and forth," said Mohammed Zarabi, president of the board of directors. "Maybe he needs some money. I can't say what his intention was. I just hope it doesn't happen again."

The center has some 500 members, mostly of Afghan descent, and has been in the city for two decades.

This week's shootings in Oregon and Connecticut have revived the perennial debate about gun control in the United States, a country that regularly has to cope with such apparently random killings.

Friday's massacre at the Sandy Hook Elementary School in Newtown, Connecticut was the second deadliest US school shooting, after the 2007 campus shootings at Virginia Tech University, which left 32 dead.

- AFP/ck



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HC allows auction of 25 quarries in Punjab

CHANDIGARH: Around four months after banning all mining activities, the Punjab and Haryana high court on Friday allowed auction of 25 quarries in various districts of Punjab.

While permitting the state to initiate the process of auctioning the mining quarries under a close and strict monitoring mechanism, the court of Justice Rajive Bhalla observed that the system of issuing manual slips for lifting minerals from the quarries was being misused.

The court also issued directions to instal weighing machines at the quarries to keep a tab on each vehicle's weight to prevent contractors from extracting material in addition to the prescribed limit by over-digging and thereby harming the ecology.

In August this year, the HC had imposed complete and immediate ban on mining in the state without environmental clearance in operational quarries of up to five hectares in the state.

The court also directed that environment impact assessment committee would grant permission in each case so that there was no ecological degradation. The HC has also told the trial courts to avoid releasing vehicles and equipment used for illegal mining.

The division bench also made it clear that the HC's endeavour was only to ensure the undertaking of mining after obtaining requisite permission and following the rules, which was not being done.

Justice Bhalla was miffed over the recent statements made by the state governments that rates of building material have reached all time high because of stay on mining by the Punjab and Haryana high court.

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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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Conn. Shooter Adam Lanza: 'Obviously Not Well'












Adam Lanza of Newtown, Connecticut was a child of the suburbs and a child of divorce who at age 20 still lived with his mother.


This morning he appears to have started his day by shooting his mother Nancy in the face, and then driving to nearby Sandy Hook Elementary School armed with at least two handguns and at least one semi-automatic rifle.


There, before turning his gun on himself, he shot and killed 20 children, who President Obama later described as between five and 10 years of age. Six adults were also killed at the school. Nancy Lanza was found dead in her home.


A relative told ABC News that Adam was "obviously not well."


Family friends in Newtown also described the young man as troubled and described Nancy as rigid. "[Adam] was not connected with the other kids," said Barbara Frey, who also said he was "a little bit different ... Kind of repressed."


State and federal authorities believe his mother may have once worked at the elementary school where Adam went on his deadly rampage, although she was not a teacher, according to relatives, perhaps a volunteer.


Nancy and her husband Peter, Adam's father, divorced in 2009. When they first filed for divorce in 2008, a judge ordered that they participate in a "parenting education program."


Peter Lanza, who drove to northern New Jersey to talk to police and the FBI, is a vice president at GE Capital and had been a partner at global accounting giant Ernst & Young.




Adam's older brother Ryan Lanza, 24, has worked at Ernst & Young for four years, apparently following in his father's footsteps and carving out a solid niche in the tax practice. He too was interviewed by the FBI. Neither he nor his father is under any suspicion.


"[Ryan] is a tax guy and he is clean as a whistle," a source familiar with his work said.


Police had initially identified Ryan as the killer. Ryan sent out a series of Facebook posts saying it wasn't him and that he was at work all day. Video records as well as card swipes at Ernst & Young verified his statement that he had been at the office.


Investigators are looking into whether Adam Lanza was carrying his older brother Ryan's identification at the time of the shooting, which may have caused the confusion. Neither Adam nor Ryan has any known criminal history.


Numerous relatives of the Lanzas in New Jersey, Connecticut, Massachusetts, as well as multiple friends, are being interviewed by the FBI in an effort to put together a better picture of the gunman and any explanation for today's tragedy.


"I think the most important thing to point out with this kind of individual is that he did not snap this morning and decide to act out violently," said former FBI profiler Mary Ellen O'Toole. "These acts involve planning and thoughtfulness and strategizing in order to put the plan together so what may appear to be snap behavior is not that at all."


With reporting by Pierre Thomas, Jim Avila, Santina Leuci, Aaron Katersky, Matthew Mosk, Jason Ryan and Jay Shaylor


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