Obama Offers Newtown 'Love and Prayers of a Nation'

President Obama told the grieving community of Newtown, Conn., that the nation has wept with them for the loss of 20 children and six teachers and school staff members killed in a senseless massacre.

Grim-faced, Obama took the stage at Newtown High School auditorium to speak at a memorial service for the first graders, teachers, principal and other school staff members killed Friday by 20-year-old Adam Lanza at the Sandy Hook Elementary School.

"I come to offer the love and prayers of a nation," the president said. "I am very mindful that mere words cannot match the depths of your sorrow nor can they heal your wounded hearts. I can only hope it helps to know you are not alone ... and that all across this land we have wept with you."

The memorial service had been delayed nearly an hour as Obama met with families of the victims -- 20 first graders and six adults -- in classrooms of the high school, but the audience sat patiently awaiting the service.

The president walked in shortly before 8 p.m., gave a brief wave to the room full of parents, friends and neighbors, before taking a seat in the first row.

He was greeted with a standing ovation as he the auditorium, and quickly took his seat in the first row to await his turn to speak in the interfaith memorial service.

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"We needed this. We needed to be together, here in this room, in the gymnasium, outside the doors of this school, in living rooms around the world, we needed to be together to show that we are together and united," said Rev. Matt Crebbin, senior minister of the Newtown Congregational Church, who opened the ceremony.

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

"We gather in such a moment of heartbreak for all of us in Newtown," he said. "We gather esp mindful of family and friends and neighbors among us who have lost loved ones by an act of unfathomable violence and destruction.

"These darkest days of our community shall not be the final word heard from us," he said

Tragedy struck the small town Friday when Adam Lanza broke into the elementary school with a semiautomatic rifle and two handguns, and then killed 20 first graders and six school staff members before committing suicide as police arrived on the scene.

CLICK HERE to read about the 'hero teacher,' the principal and 20 children who lost their lives.

The audience showed no signs of impatience, despite the delayed start. They sat quietly until a group of state police arrived at the already packed high school auditorium, but then stood to give the police a standing ovation and hugs.

A short time later more police arrived, and were also greeted with applause and hugs.

Assuming a consoling role that has become all too familiar for this presidency, Obama will also privately meet with some of the families affected by the tragic shooting, as well as local first responders.

The president has witnessed five mass shootings since assuming office in 2009, his reaction to this most recent tragedy in New England being his most publicly emotional. On Friday, tears collected in his eyes as he addressed the nation after the tragedy.

"The majority of those who died today were children, beautiful little kids between the ages of 5 and 10 years old," the president said, pausing to collect himself. "They had their entire lives ahead of them -- birthdays, graduations, weddings, kids of their own."

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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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N. Korea mourns late leader

SEOUL: North Korea on Monday mourned the death one year ago of leader Kim Jong-Il, with its rocket scientists taking pride of place at a special memorial ceremony led by his son and successor Kim Jong-Un.

Kim Jong-Il died of a heart attack on December 17, 2011, although his death was only announced two days later.

Monday's ceremony, attended by hundreds of top party and military cadres, was held in the Kumsusan Palace of the Sun in Pyongyang, which houses the embalmed bodies of Kim Jong-Il and his father and founding president Kim Il-Sung.

In the city's main square, people left floral tributes at the foot of giant statues of the two Kims, with state media saying at least 750,000 mourners had paid their respects on Sunday alone.

The official mourning -- broadcast live on state TV -- saw Kim Jong-Un and his wife Ri Sol-Ju lead rows of officials in bowing deeply to two giant statues of his father and grandfather inside the memorial hall.

The stone-faced officials clad in black were led by goose-stepping soldiers carrying a big floral tribute with a ribbon message reading, "The great comrades Kim Jong-Il and Kim Il-Sung stay with us forever."

A group of scientists who worked on the North's successful long-range rocket launch last week were among the first to pay tribute.

"These are scientists who made great contributions to the successful launch of our Kwangmyongsong-3 satellite and helped showcase the nation's scientific technologies to the whole world," the TV announcer said.

The Kim family has ruled the isolated, impoverished but nuclear-armed nation for more than six decades with an iron fist and a pervasive personality cult.

- AFP/ck

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Railways to adopt PPP mode for modernization: Bansal

SANGRUR: Union railway minister Pawan Bansal said on Sunday that public private partnership (PPP) mode would be adopted for modernizing and upgrading the railway infrastructure.

The minister, who was in Sangrur and Barnala districts of Punjab to lay the foundation stones for new railway projects, said that Rs 1.10 lakh crore would be generated through PPP mode for implementing the revamping plan.

"Railways is failing in mobilizing the required funds through internal sources. The annual plan for the ongoing fiscal has been cut short by over Rs 4,000 crore and the plan outlay has been reduced from earlier Rs 60,100 crore to Rs 55,900 crore," he said.

Bansal, who belongs to Tapa town of Barnala district, said, "The railways has chalked out ambitious plans for doubling the tracks, electrification, laying of new railway lines and manufacture of coaches in the next five years. All this will be done on PPP mode."

Bansal said that railways will need about 30,000 more coaches in the coming years and for this, all the states have been asked to provide land on which railways will set up coach factories.

"Both Punjab and Haryana have already shown keen interest in the plan," said Bansal.

He said that presently, there are 14,000 unmanned railway crossings in India and the railways is inching towards making these manned in a phased manner.

Bansal said that the Kolkata-Ludhiana and Delhi-Mumbai freight corridors will be completed during the next five years.

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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

(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.

      (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.

(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.”

(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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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

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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.

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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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