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)

Read More..

Obama picks Kerry for top diplomatic post: TV

WASHINGTON - President Barack Obama has chosen Senator John Kerry to succeed Hillary Clinton as US secretary of state, news networks CNN and ABC reported Saturday.

CNN cited a Democratic source who had spoken to Kerry, while ABC mentioned unnamed sources. Asked for comment by AFP, the White House did not immediately confirm the reports, but Kerry is seen as a frontrunner for the role.

The defeated 2004 Democratic presidential candidate, Kerry is currently head of the powerful Senate Foreign Relations committee.

On Thursday, Obama's ambassador to the United Nations, Susan Rice, withdrew her name from consideration for the secretary of state post, effectively elevating Kerry to the prohibitive favorite.

Rice had come under fire over controversial statements about the deadly September 11 attack on a US mission in Libya, and some Republican lawmakers had vowed to block her path to becoming top diplomat.

- AFP/ir

Read More..

Smaller towns like Shimla can nourish book reading habit: Prajwal Parajuly

SHIMLA: Young Indian author Prajwal Parajuly, who has earned the sobriquet of "harbinger of resurgence of short stories" in literary circles in South Asian literature and created a sensation in the previous year when he became the youngest Indian author to land an international multi-country two-book deal with a renowned publication in London, is adding a creative warmth in the freezing hills of Shimla, as he gets ready with the third launch of his debut collection of short stories, "The Gurkha's Daughter" in the Queen of Hills on Sunday.

Parajuly, who deliberated his experiences of creative writing at the two-day Shimla literary festival, which began here on Saturday, told TOI, "Readers and writers are present everywhere, be it a big metro or a small town. So why not a place like Shimla for book launch, may be someone gets inspired to write. Smaller towns like Shimla and my home state Sikkim are fertile grounds to re-cultivate the book reading habits and refurbish the creative streak among young minds."

On his second visit to Shimla, Parajuly said, "There is no dearth of talent in smaller places and Shimla has been a repository of creative element, be it drama or writing. The book launch is going to happen at the famed historic Gaiety theatre, which in itself is an epitome of drama." The "Gurkha's Daughter" has a story set in a hill station of Himachal also, in Manali, titled "Let Sleeping Dogs Life," he said. "May be, readers can find something about Shimla in his upcoming novel, which also centres around Nepali speaking people," Parajuly said.

Asked about that the term "Gurkha" has come up as a heavily loaded term with several undertones, he replied, "The book is a fictional writing and I never wrote it with this intention. If, in a way, it is dispelling the myths related to the term and is eradicating the social ills related to it, it is a positive sign. It is good that people are getting to know more about Gurkhas." There is also a place called "Gurkha" existing in Nepal, he added.

After Shimla, the next place on cards for launch is Aligarh Muslim University (AMU), apart from big places like Bangalore and across the globe, including London, Sydney, Johannesburg, Cambridge and Oxford, he said. Speaking about his book of short stories that chronicles the lives of Nepali speaking diaspora across places, Parajuly said, "I chose the topic of Nepali-speaking people as writing about a world which I knew very well and am familiar with was easy."

Asked about the title of the book "The Gurkha's Daughter," he said it has been taken from one of the short stories and was decided after much deliberation. "Earlier, we had decided upon titles like Himalayan Sons, From Himalayas, etc. but the Gurkha title captured the essence of the collection of stories," he said. The response, sales and reviews of the book so far have been phenomenal and the response in Shimla before the launch too has been quite encouraging, he added.

Read More..

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 .

Read More..

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 very rigid. "[Adam] was not connected with the other kids," said one friend.

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.

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

MORE: 27 Dead, Mostly Children, at Connecticut Elementary School Shooting

LIVE UPDATES: Newton, Conn. School Shooting

Click Here for the Blotter Homepage.

Read More..

NATO says Syrian Scuds hit "near" Turkey

BEIRUT (Reuters) - NATO accused Syrian President Bashar al-Assad's forces of firing Scud missiles that landed near to the Turkish border, in explaining why it was sending anti-missile batteries and troops to the bloc's frontier.

The Syrian government, which finds itself under attack from rebels in the capital Damascus and by a diplomatic alliance of Arab and Western powers, denies firing such long-range, Soviet-built rockets and had no immediate comment on the latest charge.

Admiral James Stavridis, the American who is NATO's military commander, wrote in a blog on Friday: "Over the past few days, a handful of Scud missiles were launched inside Syria, directed by the regime against opposition targets. Several landed fairly close to the Turkish border, which is very worrisome."

It was not clear how close they came. NATO member Turkey, once friendly toward Assad but now among the main allies of the rebels, has complained of occasional bullets and artillery fire, some of which has been fatal, for many months. It sought the installation of missile defenses on its border some weeks ago.

"Syria is clearly a chaotic and dangerous situation; but we have an absolute obligation to defend the borders of the alliance from any threat emanating from that troubled state," Stavridis wrote.

Batteries of U.S.-made Patriot missiles, designed to shoot down the likes of the Scuds popularly associated with Iraq's wars under Saddam Hussein in the 1990s, are about to be deployed by the U.S., German and Dutch armies, each of which is sending up to 400 troops to operate and protect the rocket systems.

The Syrian government has accused Western powers of backing what it portrays as a Sunni Islamist "terrorist" attack on it and says Washington and Europe have publicly voiced concerns of late that Assad's forces might resort to chemical weapons solely as a pretext for preparing a possible military intervention.

In contrast to NATO's air campaign in support of Libya's successful revolt last year against Muammar Gaddafi, Western powers have fought shy of intervention in Syria. They have cited the greater size and ethnic and religious complexity of a major Arab state at the heart of the Middle East - but have also lacked U.N. approval due to Russia's support for Assad.

Moscow reacted angrily on Friday to the way U.S. officials seized on comments by a top Kremlin envoy for the Middle East as evidence that Russia was giving up on Assad. Comments by Mikhail Bogdanov on Thursday in which he conceded Assad might be ousted did not reflect a change in policy, the Foreign Ministry said.

Assad's diplomatic isolation remains acute, however, as Arab and Western powers this week recognized a new, united coalition of opposition groups as Syria's legitimate leadership. Large parts of the country are no longer under the government's control and fighting has been raging around Damascus itself.

European Union leaders who met in Brussels on Friday said all options were on the table to support the Syrian opposition, raising the possibility that non-lethal military equipment or even arms could eventually be supplied.

In their strongest statement of support for the Syrian opposition since the uprising began 20 months ago, EU leaders instructed their foreign ministers to assess all possibilities to increase the pressure on Assad.

With rebels edging into the capital, a senior NATO official said that Assad is likely to fall and the Western military alliance should make plans to protect against the threat of his chemical arsenal falling into the wrong hands.

HUNGER SPREADS

Desperation for food is growing in parts of Syria and residents of the northern city of Aleppo say fist fights and dashes across the civil war front lines have become part of the daily struggle to secure a loaf of bread.

"I went out yesterday and could not get any bread. If only the problem was just lack of food - there is also a huge shortage of fuel, which the bakeries need to run," said Ahmed, a resident of the battle-scarred Salaheddine district.

He said people get into fist fights over flour and rebels regularly have to break up fights by firing into the air.

The World Food Programme (WFP) says as many as a million people may go hungry this winter, as worsening security conditions make it harder to reach conflict zones.

Forty thousand people have now been killed in the most enduring and destructive of the Arab revolts. The government severely limits press and humanitarian access to the country.

U.N. humanitarian chief Valerie Amos said on Friday the United Nations is committed to maintaining aid operations in Syria.

"NOTHING OFF THE TABLE"

At the EU summit, Britain's David Cameron pushed for an early review of the arms embargo against Syria to possibly open the way to supply equipment to rebels in the coming months. Germany and others were more reluctant and blocked any quick move. But there was widespread agreement that whatever action can be taken under current legislation should be pursued, and the arms embargo would still be reviewed at a later stage.

"I want a very clear message to go to President Assad that nothing is off the table," Cameron told reporters at the end of a two-day summit. "I want us to work with the opposition ... so that we can see the speediest possible transition in Syria.

"There is no single simple answer, but inaction and indifference are not options."

Among factors holding Western powers back from arming the rebels is the presence in their ranks of anti-Western Islamist radicals. Following a U.S. decision this week to blacklist one such group, Jabhat al-Nusra, a "terrorist" group, thousands of Syrians demonstrated on Friday against ostracizing the movement.

The latest, weekly Friday protests in rebel-held areas were held under the slogan: "The only terrorism in Syria is Assad's".

Inspired by Arab uprisings across the region, Syrian protesters were met with gunfire by Assad's security forces in March 2011. Armed revolt overtook the movement, which has become increasingly sectarian - waged by majority Sunni Muslims against forces loyal to Assad, who is from the minority Alawite sect, an offshoot of the Shi'ite Islam practiced in Assad's ally Iran.

A video posted on the Internet showed dozens of Sunni rebels dressed in camouflage gear congratulating and kissing each other outside a burning Shi'ite shrine.

A fighter holding a rifle said the group was destroying the "dens of the Shi'ites". Reuters could not independently verify the video, which was posted on YouTube on Wednesday and purports to be filmed in the northern town of Jisr al-Shughur.

(Writing by Oliver Holmes and Alastair Macdonald; Editing by Michael Roddy)

Read More..

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

Read More..

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.

Read More..

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 .

Read More..

Health-Exchange Deadline Looms

All of the Affordable Care Act, also known as "Obamacare," doesn't go into effect until 2014, but states are required to set up their own health care exchanges or leave it to the federal government to step in by next year. The deadline for the governors' decisions is Friday.

The health insurance exchanges are one of the key stipulations of the new health care law. They will offer consumers an Internet-based marketplace for purchasing private health insurance plans.

But the president's signature health care plan has become so fraught with politics that whether governors agreed to set up the exchanges has fallen mostly along party lines.

Such partisanship is largely symbolic because if a state opts not to set up the exchange, the Department of Health and Human Services will do it for them as part of the federal program. That would not likely be well-received by Republican governors, either, but the law forces each state's chief executive to make a decision one way or the other.

Here's what it looks like in all 50 states and the District of Columbia:

20 states that have opted out -- N.J., S.C., La., Wis., Ohio, Maine, Ala., Alaska, Ariz., Ga., Pa., Kan., Neb., N.H., N.D., Okla., S.D., Tenn., Texas and Wyo.

Charles Dharapak/AP Photo

Obama Denounces Right-to-Work Laws at Visit to Auto Plant Watch Video

Washington, D.C., Gridlocked as Fiscal Cliff Approaches Watch Video

Several Republican governors have said they will not set up the exchanges, including Chris Christie (N.J.), Nikki Haley (S.C.), Bobby Jindal (La.), Scott Walker (Wis.), John Kasich (Ohio), Paul LePage (Maine), Robert Bentley (Ala.), Sean Parnell (Ark.), Jan Brewer (Ariz.), Nathan Deal (Ga.), Tom Corbett (Pa.), Sam Brownback (Kan.), Dave Heineman (Neb.), John Lynch (N.H.), Jack Dalrymple (N.D.), Mary Fallin (Okla.), Dennis Daugaard (S.D.), Bill Haslam (Tenn.), Rick Perry (Texas), and Matt Mead (Wyo.).

3 States Out, but a Little More Complicated -- Mont., Ind. and Mo.

The Montana outgoing and incoming governors are both Democrats, but the Republican state legislature rejected the Democratic state auditor's request to start setting up a state exchange. So a federal exchange will be set up in Montana as well.

The Indiana outgoing and incoming governors are both Republicans and outgoing Gov. Mitch Daniels deferred the decision to governor-elect and U.S. Rep. Mike Pence, who said his preference is not to set up a state health care exchange, paving the way for the feds to come in too.

In Missouri, Gov. Jay Nixon is a Democrat, but Prop E passed on Nov. 6, which barred his administration from creating a state-based exchange without a public vote or the approval of the state legislature. After the election, he sent a letter to the Department of Health and Human Services saying he would be unable to set up a state-based exchange, meaning the federal government would have to set up its own.

1 State Waiting for the White House -- Utah

Utah already has a state exchange set up, a Web-based tool where small-business employees can shop and compare health insurance with contributions from their employee. In a letter Republican Gov. Gary Herbert sent to the White House Tuesday, he asked for its exchange, called Avenue H, to be approved as a state-based exchange under the Affordable Care Act as long as state officials can open it to individuals and larger businesses.

Norm Thurston, the state's health reform implementation coordinator, says authorities there "haven't received an official response" from the White House, but "we anticipate getting one soon."

There are some sticking points that don't comply with the exchanges envisioned by the Affordable Care Act and Utah would like to keep it that way.

Read More..