Japan's LDP surges back to power, eyes two-thirds majority with ally

TOKYO (Reuters) - Japan's conservative Liberal Democratic Party (LDP) surged back to power in an election on Sunday just three years after a devastating defeat, giving ex-Prime Minister Shinzo Abe a chance to push his hawkish security agenda and radical economic recipe.

An LDP win will usher in a government committed to a tough stance in a territorial row with China, a pro-nuclear energy policy despite last year's Fukushima disaster and a potentially risky prescription for hyper-easy monetary policy and big fiscal spending to beat deflation and tame a strong yen.

Exit polls by television broadcasters showed the LDP winning nearly 300 seats in parliament's powerful 480-member lower house, while its ally, the small New Komeito party, looked set to win about 30 seats.

That would give the two parties the two-thirds majority needed to over-rule parliament's upper house, where they lack a majority and which can block bills, which would help to break a policy deadlock that has plagued the world's third biggest economy since 2007.

"We need to overcome the crisis Japan is undergoing. We have promised to pull Japan out of deflation and correct a strong yen. The situation is severe, but we need to do this," Abe said on live TV. "The same goes for national security and diplomacy."

Parliament is expected to vote Abe in as prime minister on December 26.

Analysts said that while markets had already pushed the yen lower and share prices higher in anticipation of an LDP victory, stocks could rise further and the yen weaken if the "super majority" was confirmed.

Top executives of the LDP and the New Komeito confirmed that they would form a coalition. "The basis, of course, is a coalition between the LDP and the New Komeito. But if there's room to cooperate with Japan Restoration Party, we need to do so," said LDP Secretary-General Shigeru Ishiba, referring to a new, right-leaning party that was set to pick up about 46 seats.

"I think there is room to do this in the area of national defense," he said, referring to cooperation with the Japan Restoration Party. The New Komeito is more moderate than the LDP on security issues.

DEMOCRATS' DEBACLE

Exit polls showed Prime Minister Yoshihiko Noda's Democratic Party of Japan (DPJ) winning only 65 seats, just over a fifth of its tally in 2009.

The DPJ, which swept to power in 2009 promising to pay more heed to consumers than companies and reduce bureaucrats' control over policymaking, was hit by defections just before the vote.

Party executive Kohei Otsuka told NHK that Noda would likely have to quit the party leadership over the defeat, in which several party heavyweights lost their seats.

Many voters had said the DPJ failed to meet election pledges as it struggled to govern and cope with last year's huge earthquake, tsunami and nuclear disaster, and then pushed through an unpopular sales tax increase with LDP help.

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.

LDP leader Abe, 58, who quit as premier in 2007 citing ill health after a troubled year in office, 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 Senkaku islands are inherently Japanese territory," Abe said, referring to the islands that China calls the Diaoyu. "I want to show my strong determination to prevent this from changing."

But he also said he had no intention of worsening relations with China

The soft-spoken grandson of a prime minister, who would 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.

China's official Xinhua news agency, noting the deterioration in relations with Japan, warned it not to continue its lurch to the right.

"An economically weak and politically angry Japan will not only hurt the country, but also hurt the region and the world at large," Xinhua said. "Japan, which brought great harm and devastation to other Asian countries in World War II, will raise further suspicions among its neighbors if the current political trend of turning right is not stopped in time."

"UNLIMITED" MONETARY EASING

The LDP, which promoted atomic energy during its decades-long reign, is expected to be friendly to nuclear utilities, although deep public safety concerns remain a barrier to business-as-usual for the industry.

Abe has called for "unlimited" monetary easing and big spending on public works to rescue the economy from its fourth recession since 2000. Such policies, a centerpiece of the LDP's platform for decades, have been criticized by many as wasteful pork-barrel politics.

"Quantitative easing by the BOJ will help correct a strong yen and push up stock prices," Abe said ."That will help boost investment and lead to rises in wages, jobs and household revenues. We'd like to shorten the time needed for this to happen."

Kyodo news agency said the new government could draft an extra budget for 2012/13 worth up to 10 trillion yen ($120 billion) and issue debt to pay for it.

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

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

"It's a pretty big win for the LDP. Abe's economic policies will be implemented so the economy will improve next year. The problem is what happens after that," said Koichi Haji, chief economist at NLI Research Institute.

"Japan can't spend on public works for ever and the Bank of Japan's monetary easing won't keep the yen weak for too long. The key is whether Abe can implement long-term structural reforms and growth strategies."

Japan's economy has been stuck in the doldrums for decades, its population ageing fast and big corporate brands faltering, making "Japan Inc" a synonym for decline.

Consumer electronics firms such as Sony Corp are struggling with competition from foreign rivals and burdened by a strong yen, which makes their products cost more overseas.

(Additional reporting by Chikafumi Hodo, Yoko Kubota, Kiyoshi Takenaka, Leika Kihara and Mari Saito in TOKYO, Yoshiyuki Osada in OSAKA and Sui-Lee Wee in BEIJING; Editing by Robert Birsel and Raju Gopalakrishnan)

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Disputed islands are Japan's: Shinzo Abe

TOKYO: Shinzo Abe, who piloted his Liberal Democratic Party to victory in Sunday's election, said there is no doubt about Japan's ownership of islands at the centre of a dispute with China.

"China is challenging the fact that (the islands) are Japan's inherent territory," said Abe, who is expected to become prime minister. "Our objective is to stop the challenge. We don't intend to worsen relations between Japan and China."

Meanwhile, Japanese Prime Minister Yoshihiko Noda on Sunday conceded defeat in the general election and said he was stepping down as leader from his humbled governing party.

"I will resign as the head of the Democratic Party of Japan because I take this result seriously," he told a press conference. "I want to deeply apologise as I could not produce results."

Noda was speaking after NHK television, citing forecasts based on both official results and its own exit polls, said the Liberal Democratic Party had won at least 255 seats with 95 seats undecided, against 39 seats for the DPJ.

The LDP is expected to easily secure a majority of the 480-seat chamber with New Komeito, its junior coalition partner, which is expected to win at least 25 seats, NHK said.

Asked why the DPJ suffered such a haemorrhaging of support, Noda said: "We were unable to live up to people's expectations when we came into government (in 2009)."

"Politicians must take responsibility for results. The biggest responsibility for such a severe defeat lies with me as the party leader."

- AFP/xq

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West Bengal opposes direct cash transfer

KOLKATA: After Odisha and Tripura, West Bengal has opposed the Centre's direct cash transfer to bank accounts of beneficiaries claiming it would lead to breakdown of the existing public distribution system and closure of the Food Corporation of India.

"The basic objective of the public distribution system to arrest hunger among the poor will be defeated if the beneficiaries are provided cash instead of cheap food leading to closure of the Food Corporation of India," minister for food and supplies Jyotipriya Mullick said.

He said that the purpose of setting up the FCI to provide cereals and pulses at subsidised rates to the people, would be defeated since beneficiaries could use the cash for other purposes than food.

"The decision is wrong. FCI will close down if cash transfer is implemented," he said.

Noting that only 24 per cent of the population in the state have Adhar cards, he said, "How can it be possible when a large number of people in West Bengal do not have adhar cards?"

Earlier, Odisha Food minister PK Deb had dubbed the step as impractical saying many people in his state did not have bank accounts.

Tripura food and civil supply minister Manik De had said that he had written to the food and public distribution minister KV Thomas to withdraw the proposal and clarify how the new system would help the poor.

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Fewer health care options for illegal immigrants

ALAMO, Texas (AP) — For years, Sonia Limas would drag her daughters to the emergency room whenever they fell sick. As an illegal immigrant, she had no health insurance, and the only place she knew to seek treatment was the hospital — the most expensive setting for those covering the cost.

The family's options improved somewhat a decade ago with the expansion of community health clinics, which offered free or low-cost care with help from the federal government. But President Barack Obama's health care overhaul threatens to roll back some of those services if clinics and hospitals are overwhelmed with newly insured patients and can't afford to care for as many poor families.

To be clear, Obama's law was never intended to help Limas and an estimated 11 million illegal immigrants like her. Instead, it envisions that 32 million uninsured Americans will get access to coverage by 2019. Because that should mean fewer uninsured patients showing up at hospitals, the Obama program slashed the federal reimbursement for uncompensated care.

But in states with large illegal immigrant populations, the math may not work, especially if lawmakers don't expand Medicaid, the joint state-federal health program for the poor and disabled.

When the reform has been fully implemented, illegal immigrants will make up the nation's second-largest population of uninsured, or about 25 percent. The only larger group will be people who qualify for insurance but fail to enroll, according to a 2012 study by the Washington-based Urban Institute.

And since about two-thirds of illegal immigrants live in just eight states, those areas will have a disproportionate share of the uninsured to care for.

In communities "where the number of undocumented immigrants is greatest, the strain has reached the breaking point," Rich Umbdenstock, president of the American Hospital Association, wrote last year in a letter to Obama, asking him to keep in mind the uncompensated care hospitals gave to that group. "In response, many hospitals have had to curtail services, delay implementing services, or close beds."

The federal government has offered to expand Medicaid, but states must decide whether to take the deal. And in some of those eight states — including Texas, Florida and New Jersey — hospitals are scrambling to determine whether they will still have enough money to treat the remaining uninsured.

Without a Medicaid expansion, the influx of new patients and the looming cuts in federal funding could inflict "a double whammy" in Texas, said David Lopez, CEO of the Harris Health System in Houston, which spends 10 to 15 percent of its $1.2 billion annual budget to care for illegal immigrants.

Realistically, taxpayers are already paying for some of the treatment provided to illegal immigrants because hospitals are required by law to stabilize and treat any patients that arrive in an emergency room, regardless of their ability to pay. The money to cover the costs typically comes from federal, state and local taxes.

A solid accounting of money spent treating illegal immigrants is elusive because most hospitals do not ask for immigration status. But some states have tried.

California, which is home to the nation's largest population of illegal immigrants, spent an estimated $1.2 billion last year through Medicaid to care for 822,500 illegal immigrants.

The New Jersey Hospital Association in 2010 estimated that it cost between $600 million and $650 million annually to treat 550,000 illegal immigrants.

And in Texas, a 2010 analysis by the Health and Human Services Commission found that the agency had provided $96 million in benefits to illegal immigrants, up from $81 million two years earlier. The state's public hospital districts spent an additional $717 million in uncompensated care to treat that population.

If large states such as Florida and Texas make good on their intention to forgo federal money to expand Medicaid, the decision "basically eviscerates" the effects of the health care overhaul in those areas because of "who lives there and what they're eligible for," said Lisa Clemans-Cope, a senior researcher at the Urban Institute.

Seeking to curb expenses, hospitals might change what qualifies as an emergency or cap the number of uninsured patients they treat. And although it's believed states with the most illegal immigrants will face a smaller cut, they will still lose money.

The potential impacts of reform are a hot topic at MD Anderson Cancer Center in Houston. In addition to offering its own charity care, some MD Anderson oncologists volunteer at a county-funded clinic at Lyndon B. Johnson General Hospital that largely treats the uninsured.

"In a sense we've been in the worst-case scenario in Texas for a long time," said Lewis Foxhall, MD Anderson's vice president of health policy in Houston. "The large number of uninsured and the large low-income population creates a very difficult problem for us."

Community clinics are a key part of the reform plan and were supposed to take up some of the slack for hospitals. Clinics received $11 billion in new funding over five years so they could expand to help care for a swell of newly insured who might otherwise overwhelm doctors' offices. But in the first year, $600 million was cut from the centers' usual allocation, leaving many to use the money to fill gaps rather than expand.

There is concern that clinics could themselves be inundated with newly insured patients, forcing many illegal immigrants back to emergency rooms.

Limas, 44, moved to the border town of Alamo 13 years ago with her husband and three daughters. Now single, she supports the family by teaching a citizenship class in Spanish at the local community center and selling cookies and cakes she whips up in her trailer. Soon, she hopes to seek a work permit of her own.

For now, the clinic helps with basic health care needs. If necessary, Limas will return to the emergency room, where the attendants help her fill out paperwork to ensure the government covers the bills she cannot afford.

"They always attended to me," she said, "even though it's slow."

___

Sherman can be followed on Twitter at https://twitter.com/chrisshermanAP .

Plushnick-Masti can be followed on Twitter at https://twitter.com/RamitMastiAP .

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School Shooting: Officials Seek Details on Gunman

The FBI is in at least three states interviewing relatives and friends of the elementary school gunman who killed 20 children, seven adults and himself, trying to put together a better picture of the shooter and uncover any possible explanation for the massacre, ABC News has learned.

The authorities have fanned out to New Jersey, Connecticut and Massachusetts to interview relatives of Adam Lanza, 20, and his mother, who was one of Lanza's shooting victims.

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

The victims died Friday when Lanza invaded Sandy Hook Elementary School in Newtown, Conn., and sprayed staff and students with bullets, officials said. Lanza also was found dead in the school.

Lt. Paul Vance said 18 children died in the school and two more died later in a hospital.

Six adults also were slain, bringing the total to 26. Among them was the school's principal, Dawn Hochsprung, multiple sources told ABC News. Another adult victim was teacher Vicki Soto, her cousin confirmed.

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

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

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

Newtown Teacher Kept 1st Graders Calm During Massacre Watch Video

Newtown School Shooting: What to Tell Your Kids Watch Video

Lanza then drove to the elementary school and continued his rampage, authorities said.

It appeared that Lanza died from what was believed to be a self-inflicted gunshot wound. The rifle was found in his car.

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

CLICK HERE for more photos from the scene.

In the early confusion surrounding the investigation, federal sources initially identified the suspect as Adam's older brother Ryan Lanza, 24. Identification belonging to Ryan Lanza was found at the shooting scene, federal sources told ABC News.

Ryan Lanza soon took to Facebook to say he was alive and not responsible for the shooting. He later was questioned by police.

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

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

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

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

The president had to pause to compose himself after saying these were "beautiful little kids between the ages of 5 and 10."

As he continued with his statement, Obama wiped away tears from each eye. He has ordered flags flown as half staff.

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

Friday's shooting came three days after masked gunman Jacob Roberts opened fire in a busy Oregon mall, killing two before turning the gun on himself.

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

The massacre prompted the town of Newtown to lock down all its schools and draw SWAT teams to the school, authorities said.

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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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Youths have similar ideals to govt, says ESM Goh

SINGAPORE: Singapore youths generally have the same ideals as that of the government, observed Emeritus Senior Minister Goh Chok Tong at the end of a national conversation session at the Marine Parade constituency.

Mr Goh said this will make it easier for the government to work together with the generation of the future.

"Supposing they come up with very different ideals from what we think should be for the prosperity and stability of Singapore. It's going to be very troublesome," he said.

"Supposing they had all argued about welfare state and so on, then that's very troublesome for us because we know that without resources, without economic growth and so on, a welfare state will lead us to ruins."

Some of the goals set by participants during the conversation with Marine Parade residents included a more cohesive society and more sustainable economic growth.

The 45 participants comprised youths and working adults.

Mr Goh felt that the society has, in recent years, been drifting without a clear sense of direction.

He added that having the same ideals does not mean goals can be reached if the society is divided.

Mr Goh said Singapore has never been more politically divided, so the Singapore Conversation is a very serious effort to build a new compact between the people and the government.

"The worry is as we emphasise more freedom for the people, (society) becomes more cosmopolitan, takes in more foreigners, immigrants and so on, (and) our society begins to loosen as a result of these new trends," he said.

"The old (generation) is getting smaller in proportion. The young (generation) is getting bigger, with different experiences... and if they don't get a new sense of bonding in working as a group, can you imagine how we move into the future?"

Mr Goh also pointed out even though ideals may be similar, young Singaporeans may disagree with the processes and priorities in policy-making.

Youths felt that at this stage of the conversation, ideals that surface would naturally be similar to the government. But they believed there is still space for disagreements.

"When the conversation is couched in very generic themes and terms, of course, we have the same broad general ideals and there is a consensus," said Chris Lim, a participant at the session.

"But when the minute details of policies are discussed, that's when differences will start to appear, in the ways of how we do it. This is a question that remains to be answered in the course of our national conversation."

This is the first time Mr Goh has attended the national conversation session.

He has been conducting several community conversations with his residents at Marine Parade.

Mr Goh explained that these conversations were more unstructured, where residents could discuss policy issues.

Lawrence Wong, committee member of Our Singapore Conversation, said he is satisfied with the progress and outreach, three months after the initiative started.

Mr Wong was also present at the session in Marine Parade.

He said: "We've been trying to reach out to as broad spectrum of society as possible, and I think we've had very good representation of people who come enthusiastically to share, and we've got very good ideas. There's certainly more that we can do."

Separately, at a session of Our Singapore Conversation held with the Malay Muslim community at Bukit Batok East, participants raised the issue of cultivating patriotism in every Singaporean, especially the younger generation.

"What is important to me also is that they talk about patriotism, which is something I did not find in the other conversations," said Minister of State for Social and Family Development Halimah Yacob.

"In this conversation, they say it is important within the context of building a strong national identity, reinforcing multi-culturalism, multi-racialism, that we are patriotic Singaporeans and how we continue to project that."

- CNA/xq

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Tension in UP town over construction of religious structure

LAKHIMPUR KHERI (UP): Tension prevailed in Nighasan area of the district over construction of a religious structure on a disputed piece of land.

Members of one of the groups were against the construction work in Dubha village which led to the rival members staging demonstration against them, resulting in arguments between the two factions, SDM RP Singh said.

"It also came to the fore that a legal suite involving the same land was pending in the court. Also, no permission was obtained for construction of the structure," the SDM said.

In view of this, the construction work has been stopped and both the parties have been asked to maintain peace, he said, adding that adequate police and PAC men have been deployed in the village to avert any further tension.

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Fewer health care options for illegal immigrants

ALAMO, Texas (AP) — For years, Sonia Limas would drag her daughters to the emergency room whenever they fell sick. As an illegal immigrant, she had no health insurance, and the only place she knew to seek treatment was the hospital — the most expensive setting for those covering the cost.

The family's options improved somewhat a decade ago with the expansion of community health clinics, which offered free or low-cost care with help from the federal government. But President Barack Obama's health care overhaul threatens to roll back some of those services if clinics and hospitals are overwhelmed with newly insured patients and can't afford to care for as many poor families.

To be clear, Obama's law was never intended to help Limas and an estimated 11 million illegal immigrants like her. Instead, it envisions that 32 million uninsured Americans will get access to coverage by 2019. Because that should mean fewer uninsured patients showing up at hospitals, the Obama program slashed the federal reimbursement for uncompensated care.

But in states with large illegal immigrant populations, the math may not work, especially if lawmakers don't expand Medicaid, the joint state-federal health program for the poor and disabled.

When the reform has been fully implemented, illegal immigrants will make up the nation's second-largest population of uninsured, or about 25 percent. The only larger group will be people who qualify for insurance but fail to enroll, according to a 2012 study by the Washington-based Urban Institute.

And since about two-thirds of illegal immigrants live in just eight states, those areas will have a disproportionate share of the uninsured to care for.

In communities "where the number of undocumented immigrants is greatest, the strain has reached the breaking point," Rich Umbdenstock, president of the American Hospital Association, wrote last year in a letter to Obama, asking him to keep in mind the uncompensated care hospitals gave to that group. "In response, many hospitals have had to curtail services, delay implementing services, or close beds."

The federal government has offered to expand Medicaid, but states must decide whether to take the deal. And in some of those eight states — including Texas, Florida and New Jersey — hospitals are scrambling to determine whether they will still have enough money to treat the remaining uninsured.

Without a Medicaid expansion, the influx of new patients and the looming cuts in federal funding could inflict "a double whammy" in Texas, said David Lopez, CEO of the Harris Health System in Houston, which spends 10 to 15 percent of its $1.2 billion annual budget to care for illegal immigrants.

Realistically, taxpayers are already paying for some of the treatment provided to illegal immigrants because hospitals are required by law to stabilize and treat any patients that arrive in an emergency room, regardless of their ability to pay. The money to cover the costs typically comes from federal, state and local taxes.

A solid accounting of money spent treating illegal immigrants is elusive because most hospitals do not ask for immigration status. But some states have tried.

California, which is home to the nation's largest population of illegal immigrants, spent an estimated $1.2 billion last year through Medicaid to care for 822,500 illegal immigrants.

The New Jersey Hospital Association in 2010 estimated that it cost between $600 million and $650 million annually to treat 550,000 illegal immigrants.

And in Texas, a 2010 analysis by the Health and Human Services Commission found that the agency had provided $96 million in benefits to illegal immigrants, up from $81 million two years earlier. The state's public hospital districts spent an additional $717 million in uncompensated care to treat that population.

If large states such as Florida and Texas make good on their intention to forgo federal money to expand Medicaid, the decision "basically eviscerates" the effects of the health care overhaul in those areas because of "who lives there and what they're eligible for," said Lisa Clemans-Cope, a senior researcher at the Urban Institute.

Seeking to curb expenses, hospitals might change what qualifies as an emergency or cap the number of uninsured patients they treat. And although it's believed states with the most illegal immigrants will face a smaller cut, they will still lose money.

The potential impacts of reform are a hot topic at MD Anderson Cancer Center in Houston. In addition to offering its own charity care, some MD Anderson oncologists volunteer at a county-funded clinic at Lyndon B. Johnson General Hospital that largely treats the uninsured.

"In a sense we've been in the worst-case scenario in Texas for a long time," said Lewis Foxhall, MD Anderson's vice president of health policy in Houston. "The large number of uninsured and the large low-income population creates a very difficult problem for us."

Community clinics are a key part of the reform plan and were supposed to take up some of the slack for hospitals. Clinics received $11 billion in new funding over five years so they could expand to help care for a swell of newly insured who might otherwise overwhelm doctors' offices. But in the first year, $600 million was cut from the centers' usual allocation, leaving many to use the money to fill gaps rather than expand.

There is concern that clinics could themselves be inundated with newly insured patients, forcing many illegal immigrants back to emergency rooms.

Limas, 44, moved to the border town of Alamo 13 years ago with her husband and three daughters. Now single, she supports the family by teaching a citizenship class in Spanish at the local community center and selling cookies and cakes she whips up in her trailer. Soon, she hopes to seek a work permit of her own.

For now, the clinic helps with basic health care needs. If necessary, Limas will return to the emergency room, where the attendants help her fill out paperwork to ensure the government covers the bills she cannot afford.

"They always attended to me," she said, "even though it's slow."

___

Sherman can be followed on Twitter at https://twitter.com/chrisshermanAP .

Plushnick-Masti can be followed on Twitter at https://twitter.com/RamitMastiAP .

Read More..

Critics Faulted Rice's Work on Benghazi, Africa

United Nations Ambassador Susan Rice removed herself from possible consideration as secretary of state after becoming yet another player in the divide between the left and right.

Rice, who withdrew her name Thursday, has faced months of criticism over how she characterized the Sept. 11 attack on a U.S. consulate in Benghazi, Libya. She also has come under fire for her approach to dealing with African strongmen.

Rice became a target for conservatives when she went on Sunday morning current affairs shows such as ABC News' "This Week" following the Benghazi attack and failed to characterize it as a pre-meditated act of terror. Instead, she said it was a spontaneous response to an anti-Islam film produced in the United States and cited in the region as an example of anti-Islamicism in the West.

After it became clear that Rice's assertions were untrue and elements of the Obama administration may have known that to be the case, Republican Sens. Lindsey Graham, John McCain and Kelly Ayotte said they would do whatever they could to block Rice's possible nomination to replace Hillary Clinton as secretary of state.

Susan Rice Withdraws From Consideration for Secretary of State Watch Video

GOP Senators 'Troubled' After Meeting With Ambassador Rice Watch Video

President Obama to Senator McCain: 'Go After Me' Watch Video

"This is about the role she played around four dead Americans when it seems to be that the story coming out of the administration -- and she's the point person -- is so disconnected to reality, I don't trust her," Graham said. "And the reason I don't trust her is because I think she knew better. And if she didn't know better, she shouldn't be the voice of America."

Members of the administration defended Rice. At his testimony before Congress, Gen. David Petraeus, the former CIA director, said Rice was speaking from unclassified talking points given to her by the CIA.

Senate Intelligence Committee Chairwoman Dianne Feinstein, D-Calif., reiterated what Petraeus said outside his closed-door hearing before the Senate.

"The key is that they were unclassified talking points at a very early stage. And I don't think she should be pilloried for this. She did what I would have done or anyone else would have done that was going on a weekend show," Feinstein said. "To say that she is unqualified to be secretary of state, I think, is a mistake. And the way it keeps going, it's almost as if the intent is to assassinate her character."

Minutes after she announced her withdrawal from the process, Graham tweeted, "I respect Ambassador Rice's decision."

McCain's office released a paper statement saying, "Senator McCain thanks Ambassador Rice for her service to the country and wishes her well. He will continue to seek all the facts surrounding the attack on our consulate in Benghazi that killed four brave Americans."

Over the last few weeks, criticism of Rice had grown beyond her response to Benghazi to include a closer scrutiny of her work in Africa, where she had influence over U.S. policy during the Clinton administration.

Critics of her Africa dealings were not partisan -- but included human rights workers, journalists and some Africans themselves.

Among the most serious critiques was the accusation that she actively protected Rwandan President Paul Kagame and senior members of his government from being sanctioned for funding and supporting the rebels that caused Eastern Congo's recent violence.

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