'We Can't Tolerate This Anymore,' Obama Says













President Barack Obama said at an interfaith prayer service in this mourning community this evening that the country is "left with some hard questions" if it is to curb a rising trend in gun violence, such as the shooting spree Friday at Newtown's Sandy Hook Elementary School.


After consoling victims' families in classrooms at Newtown High School, the president said he would do everything in his power to "engage" a dialogue with Americans, including law enforcement and mental health professionals, because "we can't tolerate this anymore. These tragedies must end. And to end them we must change."






Mandel Ngan/AFP/Getty Images











President Obama: 'Newtown You Are Not Alone' Watch Video









Sandy Hook Elementary Shooting: Remembering the Victims Watch Video







The president was not specific about what he thought would be necessary and did not even use the word "gun" in his remarks, but his speech was widely perceived as prelude to a call for more regulations and restrictions on the availability of firearms.


The grieving small town hosted the memorial service this evening as the the nation pieces together the circumstances that led to a gunman taking 26 lives Friday at the community's Sandy Hook Elementary School, most first graders.


"Someone once described the joy and anxiety of parenthood as the equivalent of having your heart outside your body all of the time, walking around," he said, speaking of the joys and fears of raising children.


"So it comes as a shock at a certain point when you realize no matter how much you love these kids you can't do it by yourself," he continued. "That this job of protecting kids and teaching them well is something we can only do together, with the help of friends and neighbors, with the help of a community, and the help of a nation."


CLICK HERE for Full Coverage of the Tragedy at Sandy Hook






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Egyptians narrowly back constitution, say rival camps


CAIRO (Reuters) - Egyptians voted narrowly in favor of a constitution shaped by Islamists but opposed by other groups who fear it will deepen divisions, officials in rival camps said on Sunday after the first round of a two-stage referendum.


Next week's second round is likely to give another "yes" vote as it includes districts seen as more sympathetic towards Islamists, analysts say, meaning the constitution would be approved.


But a close win, if confirmed, would give Islamist President Mohamed Mursi only limited cause for celebration as it would show a wide rift in a country where he needs to build consensus on tough measures to fix a fragile economy.


The Muslim Brotherhood's party, which propelled Mursi to office in a June election, said 56.5 percent backed the text. Official results are not expected till after the next round.


Mursi and his backers say the constitution is vital to move Egypt's democratic transition forward. Opponents say the basic law is too Islamist and tramples on minority rights, including those of Christians who make up 10 percent of the population.


The build-up to Saturday's vote was marred by deadly protests. Demonstrations erupted when Mursi awarded himself extra powers on November 22 and then fast-tracked the constitution through an assembly dominated by his Islamist allies.


However, the vote passed off calmly with long queues in Cairo and several other places, though unofficial tallies indicated turnout was around a third of the 26 million people eligible to vote this time. The vote was staggered because many judges needed to oversee polling staged a boycott in protest.


The opposition had said the vote should not have been held given violent protests in the Arab world's most populous nation, which is watched closely from abroad to see how Islamists, long viewed warily in the West, handle themselves in power.


"It's wrong to have a vote or referendum with the country in the state it is - blood and killings, and no security," said Emad Sobhy, a voter who lives in Cairo. "Holding a referendum with the country as it is cannot give you a proper result."


INCREASINGLY DIVIDED


As polls closed, Islamists attacked the offices of the newspaper of the liberal Wafd party, part of the opposition National Salvation Front coalition that pushed for a "no" vote.


"The referendum was 56.5 percent for the 'yes' vote," a senior official in the Brotherhood's Freedom and Justice Party operations room set up to monitor voting told Reuters.


The Brotherhood and its party had representatives at polling stations across the 10 areas, including Cairo, in this round. The official, who asked not to be identified, said the tally was based on counts from more than 99 percent of polling stations.


"The nation is increasingly divided and the pillars of state are swaying," opposition politician Mohamed ElBaradei wrote on Twitter. "Poverty and illiteracy are fertile grounds for trading with religion. The level of awareness is rising fast."


One opposition official also told Reuters the vote appeared to have gone in favor of Islamists who backed the constitution.


The opposition initially said its exit polls indicated the "no" camp would win comfortably, but officials changed tack during the night. One opposition official in the early hours of Sunday said it would be "very close". There was no formal statement from the opposition National Salvation Front.


"Even if this result is correct, that does not mean that this constitution can pass, because it means more than 40 percent of the people didn't agree with it," said Issam Amin, speaking on a Cairo street and echoing the opposition line that the constitution needed consensus backing not a simple majority.


A narrow loss could still hearten leftists, socialists, Christians and more liberal-minded Muslims who make up the disparate opposition camp, which has been beaten in two elections since Hosni Mubarak was overthrown last year.


They were drawn together to oppose what they saw as Mursi's power grab and his constitution push. The National Salvation Front includes prominent figures such as ElBaradei, former Arab League chief Amr Moussa and firebrand leftist Hamdeen Sabahy.


If the constitution is approved, a parliamentary election will follow early next year. Opposition leaders say the Front could help unite the opposition for that poll after their divided ranks have split the vote in previous elections.


DEADLY VIOLENCE


But analysts question whether the opposition group in this form will survive until a parliamentary election. The Islamist-dominated lower house of parliament elected earlier this year was dissolved based on a court order in June.


Violence in Cairo and other cities has plagued the run-up to the referendum. At least eight people were killed when rival camps clashed during demonstrations outside the presidential palace earlier this month.


Several party buildings belonging to the Muslim Brotherhood's party have been burned by angry protesters in recent weeks. On Friday, a day before the vote, rival factions armed with clubs, knives and swords fought in Alexandria.


In order to pass, the constitution must be approved by more than 50 percent of those casting ballots. There are 51 million were eligible voters in the nation of 83 million.


Rights groups reported some abuses, such as polling stations opening late, officials telling people how to vote and bribery. But Gamal Eid, head of the Arab Network for Human Rights Information, said abuses were not enough to invalidate the vote.


"We accepted the referendum so we accept the result," said Ahmed Mohamed, a Cairene who backed the draft. "If the majority said ‘yes', so be it. I didn't see forgery where I voted."


Islamists have been counting on their disciplined ranks of supporters and on Egyptians desperate for an end to turmoil that has hammered the economy and sent Egypt's pound to eight-year lows against the dollar.


If the constitution is voted down in a second round, which now looks unlikely, a new assembly will 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 armored 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.


(Additional reporting by Tamim Elyan, Shaimaa Fayed and Reuters Television; Writing by Edmund Blair and Giles Elgood; Editing by Andrew Heavens)



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China commentary urges policy shift as Japan votes






BEIJING: China's state media on Sunday urged Japan to seek a post-election foreign policy that will improve relations with its neighbours, as Japanese voted in a poll likely to bring in a more hawkish administration.

It came just days after Beijing's latest effort to bolster its claim to disputed islands at the centre of a fierce row with Tokyo, by submitting to the United Nations information on the outer limits of its continental shelf.

The state Xinhua news agency commentary called on whichever party comes out on top to "devise its foreign policy with a long-term and pragmatic" view so Japan can "repair its strained ties with neighbours".

Ties between the Asian giants have soured in recent months due to the row over the East China Sea islands, which are controlled by Tokyo but claimed by Beijing.

Commentators believe the dispute has given a boost to right-wingers in Japan, where the conservative Liberal Democratic Party is expected to defeat the ruling Democratic Party of Japan in Sunday's elections for parliament's lower house.

Shinzo Abe, LDP president and the likely next premier, has said he would take a harder line on foreign policy and revitalise ties with the United States.

The Xinhua commentary cited a "troubling sign" that some Japanese political parties are advocating a hardline over the country's territorial disputes.

"These policies, if carried out, will surely further sour Japan's relations with its neighbors and even increase political and military risks in the region," it said.

China's foreign ministry said on Friday that Beijing told the UN in its submission that geographical characteristics "show that the continental shelf of China in the East China Sea extends to the Okinawa Trough, an important geographical unit with remarkable partition."

Such a definition of China's continental shelf would include the disputed islands. Japan's Okinawan islands lie to the east of the trough.

The escalation in the dispute over the uninhabited islands, known as Diaoyu in China and Senkaku in Japan, was triggered when the Japanese government in September purchased some of the islands from the private Japanese owner.

The purchase triggered sometimes-violent anti-Japanese riots in China.

Ships from Japan, China and Taiwan -- which also claims the island -- have engaged in stand-offs and last week Japan scrambled fighter jets after a Chinese state-owned plane flew over the area.

- AFP/xq



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BJP slams PM's remarks on FDI

CHENNAI: BJP today criticised Prime Minister Manmohan Singh's remarks that those who oppose FDI in retail are "ignorant", saying it is not the opposition which is ignorant, but the UPA government and Congress party.

Addressing a press conference here, senior BJP leader, M Venkaiah Naidu, said the Congress-led government in Kerala opposed FDI and the NCP, which is a partner of UPA coalition, said it will take a decision on implementing FDI in Maharashtra after consultation.

The DMK, an ally of the UPA, had supported the Bharath bandh against FDI and described it as 'Foreign Direct Invasion', he said.

While the Samajwadi Party described FDI in retail as "an invitation to another East India Company" and would not implement in Uttar Pradesh, another UPA outside ally, BSP not only demanded suspension of FDI but also 'complete rollback'.

"Do you mean to say that your government in Kerala, your allies and supporting parties are ignorant, Mr Prime Minister? Who are ignorant and who will be ignored by the people will be known when people get an opportunity," Naidu said.

Addressing the annual general meeting of FICCI yesterday, the Prime Minister Manmohan Singh hit out at opponents, saying they were 'ignorant' about global realities or were constrained by 'outdated ideologies'.

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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.


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Online:


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


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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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Egyptians vote on divisive constitution


CAIRO/ALEXANDRIA (Reuters) - Egyptians queued to vote on Saturday on a constitution promoted by its Islamist backers as the way out of a prolonged political crisis and rejected by opponents as a recipe for further divisions in the Arab world's biggest nation.


Soldiers joined police to secure the referendum after deadly protests during the buildup. Street brawls erupted again on Friday in Alexandria, Egypt's second city, but voting proceeded quietly there, with no reports of violence elsewhere.


President Mohamed 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.


The liberal, secular and Christian opposition says 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 Adel Imam, a 53-year-old queuing to vote in a Cairo suburb. "The president's authorities are less than before. He can't be a dictator."


Opposition politician and Nobel Peace Prize laureate Mohamed ElBaradei wrote on Twitter: "Adoption of (a) divisive draft constitution that violates universal values and freedoms is a sure way to institutionalize instability and turmoil."


Official results will not be announced until after a second round of voting next Saturday. But partial results and unofficial tallies are likely to emerge soon after the first round, giving an idea of the overall trend.


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.


TRANSITION


Christians, making up about 10 percent of Egypt's 83 million people and who have long grumbled 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," Michael Nour, a 45-year-old Christian teacher in Alexandria. "The constitution does not represent all Egyptians," he said.


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


"I voted 'yes' for stability," said shopkeeper Ahmed Abou Rabu, 39. "I cannot say all the articles of the constitution are perfect but I am voting for a way forward. I don't want Egyptians to go in circles, for ever lost in this transition."


Mursi was among the early voters after polls opened at 8 a.m. (1:00 a.m. Eastern Time). 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.


One senior official in the committee overseeing the referendum said Saturday's vote could extend to Sunday if crowds were too heavy to allow everyone cast ballots in one day. Voting for Egyptians abroad that began on Wednesday has been extended to Monday, the state news agency reported.


After weeks of turbulence, there has been limited public campaigning. Opposition politicians and parties, beaten in two elections since Mubarak's overthrow, only announced on Wednesday they backed a "no" vote instead of a boycott.


Flag-waving Islamists gathered peacefully at one of the main mosques on Friday, some shouting "Islam, Islam" and "We've come here to say 'yes' to the constitution".


PALACE SIT-IN


Opposition supporters assembled outside the presidential palace, where there has been a sit-in for days. The walls of the palace, ringed by tanks, are scrawled with anti-Mursi graffiti.


The referendum will be held on two days covering different regions, with the second round on December 22, because there are not enough judges willing to monitor all polling stations after some in the judiciary 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 this year. 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 armored 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 Andrew Heavens)



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India PM says reforms steps "only the beginning"






NEW DELHI: India's premier Manmohan Singh said on Saturday his government's new reforms to spur the economy were "only the beginning", while lashing out at the "excessive pessimism" that he said is hurting growth.

Singh's government has initiated a string of reforms to further open up sectors such as retail, insurance and aviation to foreign investment as it seeks to kickstart growth before facing voters in 2014 elections.

"The steps we have taken are only the beginning of a process to revive our economy and take it back to its trend growth rate of eight to nine per cent," Singh told an audience of corporate leaders in New Delhi.

"Our government has acted to reverse the cycle of negative expectations and stimulate investment," he said.

But "excessive pessimism at home" and a "less supportive" global environment have made the Congress-led government's task of reviving the flagging economy much tougher, he added.

India's economic growth slipped to a near-decade low of 6.5 per cent in the last fiscal year and is expected to fall to around 5.5 per cent this year.

While much of the world would envy such a growth rate, the pace is not enough for India which says it needs close to double-digit expansion to substantially reduce crushing poverty.

"Even as we make our growth process more inclusive, we cannot lower our guard in pursuing policies that restore growth momentum to the economy," Singh said.

He said the government had taken tough decisions to rekindle investor enthusiasm and rein in the ballooning fiscal deficit which has brought warnings of a downgrade from global ratings agencies.

"Some of the decisions we have taken were politically difficult and the naysayers and the cynics have tried to halt us in our tracks," Singh said.

Parties that have been fighting the reforms, including the main opposition Hindu nationalist Bharatiya Janata Party, "are either ignorant or constrained by outdated ideologies", Singh said.

Last week the fragile minority coalition government succeeded in winning approval for its move to allow in foreign supermarkets -- a flagship of its renewed reform agenda -- despite fierce political opposition.

- AFP/xq



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Aung San Suu Kyi praises Indian Air Force pilots

YANGON: Not treated well by her own military junta, pro-democracy icon Aung San Suu Kyi today praised Indian Air Force pilots for being "professional" and "sweet".

"I enjoyed my time in India thoroughly from beginning to end, particularly impressed by the Air Force Pilots who flew me back. They are the kind of professional military men I like to see," said the 67-year-old Suu Kyi who was placed under house arrest for 15 of the past 21 years on different occasions.

She added: "They (IAF) are very very sweet. So very soldierly in the best kind of way, officers and gentlemen."

During her visit to India last month, Suu Kyi was flown in and out of Yagon by IAF pilots in military planes.

After a 40-minute meeting with Salman Khurshid, a beaming Burmese leader also so praised the kind of reception she received from the Indian government and Indian people during her visit.

"It is an experience I wish to repeat," she 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."


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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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