Schools and students are targets worldwide

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BEIJING (AP) — A half-day before a young gunman committed one of the deadliest school attacks in U.S. history, a Chinese farmer took a kitchen knife and hacked at more than 20 children as they entered their rural elementary school.


Though the outcomes are different — 28 dead in Connecticut, and 23 injured in China — the Friday attacks show how disturbingly frequent rampages against children and schools are. Attackers often seek out the vulnerable, hoping to amplify their outrage before they themselves often commit suicide. News of one mass killing often serves as inspiration and blueprint to other potential mass killers.


"It's these disaffected people who are angry at the world, who plan to take out as many people as they can, and there's some element there of notoriety," said forensic psychologist James Ogloff of Monash University in Melbourne, Australia. "It's a way of becoming infamous."


Mass killings, when an individual tries to kill as many people at one time as possible, have occurred in places as far away as Switzerland, where 14 people died in a shooting spree by an unemployed man who then killed himself in 2001, to South Korea, where a police officer killed 56 people before he blew himself up in 1982. Distinct from acts of terror that have political or collective aims, other mass killers act out of personal grievances.


Attacks against schools are a bleak subset, offering easy targets for taking down large numbers of victims. Shootings at schools have periodically occurred in Finland and Germany as well as the U.S., though the American attacks have been more frequent.


China has seen more than a half-dozen school attacks in less than three years, though the death tolls have been mostly in single digits, largely because knives have been the most-used weapon. China largely prohibits private ownership of guns.


"They choose to attack school students who are weak in defending themselves and are easily assaulted," said Zhu Zhuohong, an associate researcher in psychology at the Chinese Academy of Sciences.


Ogloff, the forensic psychologist who has studied both spree and serial killers in the U.S., Canada and Australia, said that a break-down in a relationship or a humiliating experience often acts as a triggering event for mass shooters. After Thomas Hamilton killed 16 kindergarteners and a teacher at an elementary school in Dunblane, Scotland, in 1996, reports said that he had been suspected of inappropriate behavior with boys he oversaw in a youth group and that letters he wrote talked of persecution by police and authorities for forcing him from taking part in boys clubs and for causing a business he ran to fail.


While police in Connecticut and in China have so far not given motives for Friday's attacks, both began with single assaults. Twenty-year-old Adam Lanza first shot his mother in their home in the New England town of Newtown before driving to the nearby Sandy Hook Elementary School; armed with two handguns, he shot into two classrooms, killing 20 people and six adults and then apparently shooting himself.


Min Yingjun, a 36-year-old resident of Guangshan, an area of tea and rice farms in central China, burst into the home of an elderly woman and stabbed her with a kitchen knife, the government's Xinhua News Agency reported. Min then went to the Chenpeng Village Primary School, slashing at 22 students, ages 6 to 12, as they arrived for class. Seven of the students, some with severed fingers and ears, required hospitalization, Xinhua said.


Though Min did not die — he was grabbed by police at the scene and is under arrest — Zhu, the psychologist, said many mass attacks should be seen as "expanded suicide." The attackers, often in a state of depression, believe society is malicious or unsafe and wants others to die with them, said Zhu.


Police described Min as possibly being "mentally ill," Xinhua said, and a law enforcement official briefed on the Connecticut shooting told The Associated Press that Lanza was believed to suffer from a personality disorder. But overall, said Ogloff, very few mass shooters are mentally ill.


Most perpetrators are young men, and their common traits — an interest in the military or violence — are so widespread as to make it impossible to identify potential killers, said Ogloff. Spree shootings, he said, are increasing and becoming deadlier because each killing leaves a blueprint for others to follow.


"Imagine you're a kid and you're 20 years old, and you're angry at the world and you're fascinated with the military and you're in a situation where you want to end your life. ... You're influenced by all the ones who've gone before you," said Ogloff, who has overseen the treatment of Martin Bryant, who shot 35 people at Port Arthur, a former penal colony and tourist site, in Tasmania in 1996.


The spate of school attacks in China — six in a seven-month period in 2010 — have raised concerns about copycats. News media in China, all of which are state-controlled, gave wide coverage to the Connecticut attack. But they ran the same brief Xinhua report about Friday's knifings in Guangshan, and local officials refused to provide more information, signs that authorities want to restrict the news either to prevent encouraging others or to play down the crime to keep blame off the government.


If identifying possible perpetrators is difficult, providing better access to mental health services and restricting the availability of firearms are key to reducing the numbers of victims, experts said.


"It's interesting that you have two individuals entering schools but because of the means of their attacks — one with firearms, one with a knife — there's an extreme disparity in the casualties," said Christian Chan, a professor of psychology at Hong Kong University. "It's the means that we can control, not necessarily the psychology of people. Throughout history there will always be people who might lose it."


Tight controls mean that gun crimes are rare in China and make knives and sometimes explosives the weapons used in mass attacks in China. Even so, violence is on the rise as people grow frustrated with a corrupt and often indifferent officialdom and seek other means to address grievances.


"The social environment is a factor behind attacks in China," said Ku Jianhui, a lawyer with the Beijing Xindong law firm. "A person who chooses extreme acts to voice his or her grievances usually believes that his or her cases were unable to be handled fairly through normal channels or legal procedures."


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Associated Press reporter Kristen Gelineau in Sydney, Australia, and researcher Henry Hou in Beijing contributed to this report.


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School shooting postpones Cruise premiere in Pa.

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NEW YORK (AP) — The U.S. premiere of the Tom Cruise action movie "Jack Reacher" is being postponed following the deadly Connecticut school shooting.


Paramount Pictures says "out of honor and respect for the families of the victims" the premiere won't take place Saturday in Pittsburgh, where "Jack Reacher" was filmed.


The premiere would've been Cruise's first U.S. media appearance since his split from Katie Holmes over the summer. It was to be more contained with select outlets covering and a location away from Hollywood or New York.


A proclamation ceremony for Cruise had been planned with Pennsylvania Gov. Tom Corbett and Pittsburgh Mayor Luke Ravenstahl.


No new date for the premiere has been set. The movie opens Dec. 21.


Friday's massacre at a Newtown, Conn., elementary school killed 20 children and several adults.


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Fewer health care options for illegal immigrants

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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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Police, world wonder about Conn. shooting motive

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NEWTOWN, Conn. (AP) — The massacre of 26 children and adults at a Connecticut elementary school elicited horror and soul-searching around the world even as it raised more basic questions about why the gunman, a 20-year-old described as brilliant but remote, would have been driven to such a crime and how he chose his victims.


Investigators were trying to learn more about the gunman, Adam Lanza, and questioned his older brother, who is not believed to have been involved in the rampage at Sandy Hook Elementary. Police shed no light on the motive for the nation's second-deadliest school shooting.


In tight-knit Newtown on Friday night, hundreds of people packed St. Rose of Lima church and stood outside in a vigil for the 28 dead — 20 children and six adults at the school, the gunman's mother at home, and the gunman himself, who committed suicide. People held hands, lit candles and sang "Silent Night."


"These 20 children were just beautiful, beautiful children," Monsignor Robert Weiss said. "These 20 children lit up this community better than all these Christmas lights we have. ... There are a lot brighter stars up there tonight because of these kids."


Lanza is believed to have suffered from a personality disorder and lived with his mother, said a law enforcement official who was briefed on the investigation.


Lanza shot his mother, Nancy Lanza, drove to the school in her car with at least three guns, including a high-powered rifle that he apparently left in the back of the vehicle, and shot up two classrooms around 9:30 a.m. Friday, law enforcement officials said, speaking on condition of anonymity.


A custodian ran through the halls, warning of a gunman, and someone switched on the intercom, perhaps saving many lives by letting them hear the chaos in the school office, a teacher said. Teachers locked their doors and ordered children to huddle in a corner or hide in closets as shots echoed through the building.


The well-liked principal, Dawn Hochsprung, was believed to be among the dead. A woman who worked at the school was wounded. An update on victims' identities was planned Saturday morning.


A law enforcement official speaking on condition of anonymity said investigators believe Lanza attended the school several years ago but appeared to have no recent connection to it.


At least one parent said Lanza's mother was a substitute teacher there. But her name did not appear on a staff list. And the official said investigators were unable to establish any connection so far between her and the school.


Lanza's older brother, 24-year-old Ryan Lanza, of Hoboken, N.J., was questioned, but a law enforcement official said he was not believed to have had a role in the rampage. Investigators were searching his computers and phone records, but he told law enforcement he had not been in touch with his brother since about 2010.


The officials spoke on the condition of anonymity because they were not authorized to discuss the unfolding investigation.


At one point, a law enforcement official mistakenly identified the gunman as Ryan Lanza. Brett Wilshe, a friend of Ryan Lanza's, said Lanza told him the gunman may have had his identification. Ryan Lanza apparently posted Facebook page updates Friday afternoon that read, "It wasn't me" and "I was at work."


For about two hours late Friday and early Saturday, clergy members and emergency vehicles moved steadily to and from the school. The state medical examiner's office said bodies of the victims would be taken there eventually for autopsies.


The shooter took three guns into the school — a Glock and a Sig Sauer, both pistols, and a .223-caliber Bushmaster rifle, according to an official who was not authorized to discuss information with reporters and spoke on the condition of anonymity. The weapons were registered to his slain mother.


Adam Lanza and his mother lived in a well-to-do part of prosperous Newtown, about 60 miles northeast of New York City, where neighbors are doctors or hold white-collar positions at companies such as General Electric, Pepsi and IBM.


Lanza's parents filed for divorce in 2008, according to court records. His father, Peter Lanza, lives in Stamford, Conn., and works as a tax director for General Electric.


The gunman's aunt Marsha Lanza, of Crystal Lake, Ill., said her nephew was raised by kind, nurturing parents who would not have hesitated to seek mental help for him if he needed it.


"Nancy wasn't one to deny reality," Marsha Lanza said, adding her husband had seen Adam as recently as June and recalled nothing out of the ordinary.


Catherine Urso, of Newtown, said her college-age son knew the killer and remembered him for his alternative style. "He just said he was very thin, very remote and was one of the goths," she said.


Adam Lanza attended Newtown High School, and several news clippings from recent years mention his name among the honor roll students.


Joshua Milas, who graduated from Newtown High in 2009 and belonged to the school technology club with him, said Adam Lanza was generally a happy person but that he hadn't seen him in a few years.


"We would hang out, and he was a good kid. He was smart," Joshua Milas said. "He was probably one of the smartest kids I know. He was probably a genius."


An official who spoke on condition of anonymity said it was not clear that Adam Lanza had a job, and there was no indication of law enforcement interviews or search warrants at a place of business.


The mass shooting is one of the deadliest in U.S. history, and among school attacks is second in victims only to the 2007 Virginia Tech massacre, which left 33 people dead, including the gunman. Reaction was swift and emotional in Newtown, a picturesque New England community of 27,000 people, as well as across the country and around the world.


"It has to stop, these senseless deaths," said Frank DeAngelis, principal of Colorado's Columbine High School, where a massacre in 1999 killed 15 people.


In Washington, the Coalition to Stop Gun Violence organized a vigil at the White House, with some protesters chanting, "Today IS the day" to take steps to curb gun violence. In New York's Times Square, a few dozen people held tea lights in plastic cups, with one woman holding a sign that read: "Take a moment and candle to remember the victims of the Newtown shooting."


President Barack Obama's comments on the tragedy amounted to one of the most outwardly emotional moments of his presidency.


"The majority of those who died were children — beautiful little kids between the ages of 5 and 10 years old," Obama said at a White House news briefing. He paused for several seconds to keep his composure as he teared up and wiped an eye. Nearby, two aides cried and held hands.


Australian Prime Minister Julia Gillard described the attack as a "senseless and incomprehensible act of evil."


"Like President Obama and his fellow Americans, our hearts too are broken," Gillard said in a statement.


In Japan, where guns are severely restricted and there are extremely few gun-related crimes, the attack led the news two days before nationwide parliamentary elections. In China, which has seen several knife rampages at schools in recent years, the attack quickly consumed public discussion.


At the Newtown vigil, Anthony Bloss, whose three daughters survived, said they are doing better than he. "I'm numb. I'm completely numb," he said.


The gunman entered the school through its front door, and authorities are looking into the possibility that he shattered glass next to it to get in, said Newtown Police Lt. George Sinko.


Panicked parents looking for their children raced to Sandy Hook, a kindergarten-through-fourth-grade school where police told youngsters to close their eyes as they were led from the building so that they wouldn't see the blood and broken glass.


Schoolchildren — some crying, many looking frightened — were escorted through a parking lot in a line, hands on one another's shoulders.


Robert Licata said his 6-year-old son was in class when the gunman burst in and shot the teacher. "That's when my son grabbed a bunch of his friends and ran out the door," he said. "He was very brave. He waited for his friends."


He said the shooter didn't utter a word.


Kaitlin Roig, a teacher at the school, said she implored her students to be quiet.


"I told them we had to be absolutely quiet. Because I was just so afraid if he did come in, then he would hear us and just start shooting the door. I said we have to be absolutely quiet. And I said there are bad guys out there now and we need to wait for the good guys to come get us out," Roig told ABC News.


"If they started crying, I would take their face and say it's going to be OK. Show me your smile," she said. "They said, we want to go home for Christmas. Yes, yeah. I just want to hug my mom, things like that, that were just heartbreaking."


___


Contributing to this report were Associated Press writers Pat Eaton-Robb and Matt Apuzzo and videographer Robert Ray in Newtown; Bridget Murphy in Boston; Samantha Henry in Newark, N.J.; Pete Yost in Washington; Michael Melia in Hartford; and the AP News Research Center in New York.


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Pentagon to send missiles, 400 troops to Turkey

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INCIRLIK AIR BASE, Turkey (AP) — The U.S. will send two batteries of Patriot missiles and 400 troops to Turkey as part of a NATO force meant to protect Turkish territory from potential Syrian missile attack, the Pentagon said Friday.


Defense Secretary Leon Panetta signed a deployment order en route to Turkey from Afghanistan calling for 400 U.S. soldiers to operate two batteries of Patriots at undisclosed locations in Turkey, Pentagon press secretary George Little told reporters flying with Panetta.


Germany and the Netherlands have already agreed to provide two batteries of the U.S.-built defense systems and send up to 400 German and 360 Dutch troops to man them, bringing the total number of Patriot batteries slated for Turkey to six.


German lawmakers voted 461-86 Friday to approve the deployment of two Patriot missile batteries. The mandate allows Germany to deploy a maximum 400 soldiers through January 2014. NATO foreign ministers endorsed Turkey's request for the Patriots on Nov. 30.


A number of Syrian shells have landed in Turkish territory since the conflict in the Arab state began in March 2011. Turkey has condemned the Syrian regime of President Bashar Assad, supported Syrian rebels and provided shelter to Syrian refugees. Ankara is particularly worried that Assad may get desperate enough to use chemical weapons.


During a brief stop at Incirlik Air Base, Panetta told U.S. troops that Turkey might need the Patriots, which are capable of shooting down shorter-range ballistic missiles as well as aircraft.


He said he approved the deployment "so that we can help Turkey have the kind of missile defense it may very well need to deal with the threats coming out of Syria," he said.


The U.S., Germany and the Netherlands are the only NATO members who have the upgraded PAC-3 missiles, capable of missile interception. Each battery has an average of 12 missile launchers, a NATO official said, speaking on condition of anonymity because alliance regulations do not allow him to speak on the record.


In a statement issued Friday NATO spokeswoman Oana Lungescu said "the deployment will be defensive only."


"It will not support a no-fly zone or any offensive operation. Its aim is to deter any threats to Turkey, to defend Turkey's population and territory and to de-escalate the crisis on NATO's south-eastern border," Lungescu said.


Panetta did not mention how soon the two Patriot batteries will head to Turkey or how long they might stay.


Earlier this week in Berlin, German Deputy Foreign Minister Michael Link told lawmakers that current plans call for the missile sites to be stationed at Kahramanmaras, about 60 miles north of Turkey's border with Syria. Dutch Prime Minister Mark Rutte said Thursday that the Netherlands, Germany and the U.S. are working closely with Turkey "to ensure that the Patriots are deployed as soon as possible." But he predicted they would not become operational before the end of January. Turkey joined NATO in 1952, three years after the alliance was formed.


At Incirlik Air Base, about 60 miles north of the Syrian border, an Air Force member asked Panetta what the US would do if Syria used chemical or biological weapons against the rebels. Panetta said he could not be specific in a public setting, but added, "we have drawn up plans" that give President Barack Obama a set of options in the event that U.S. intelligence shows that Syria intends to use such weapons.


Asked by another Air Force member whether he thought Syria would "react negatively" to the Patriot deployments, Panetta said, "I don't think they have the damn time to worry" about the Patriots since the regime's leaders are struggling to stay in power.


He indicated that Syria's reaction to the Patriots was not a major concern to him.


Separately, NATO will deploy its Airborne Warning and Control System aircraft, or AWACS, to Turkey on a training exercise this month, the NATO said.


He said the exercise was not connected to the deployment of the Patriots.


The aircraft, which can detect launches of ground-to-ground missiles, will exercise command and control procedures as well as test the connectivity of various NATO and Turkish communications and data sharing systems, the official said.


___


Associated Press writer Slobodan Lekic in Brussels contributed to this report.


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From 'Sherlock' to 'Star Trek' for Cumberbatch

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LONDON (AP) — Benedict Cumberbatch has had a busy 24 hours.


The British actor was nominated for a Golden Globe, chased by the paparazzi in London and unveiled the first nine minutes of the new "Star Trek" movie Friday.


At a special IMAX presentation of the footage in London, Cumberbatch's menacing character John Harrison was introduced at the beginning of the much-anticipated "Star Trek Into Darkness."


The sequel kicks off at a fast pace, with Captain Kirk's trademark quips, a volcano erupting and Spock in grave danger during a mission to save a planet.


Cumberbatch was not allowed to reveal much about the plot, but the 36-year-old did admit that he auditioned for the role of Harrison — who he describes as "a phenomenal one-man weapon of mass destruction" — on an iPhone in his friend's kitchen.


Fans wanting to see the footage can catch it in front of selected IMAX 3D screenings worldwide of "The Hobbit," beginning Friday.


"Star Trek Into Darkness," directed by J.J. Abrams, opens next May.


___


The Associated Press spoke to the "Sherlock" star Friday after the presentation.


AP: "How did it feel coming here and seeing your face so big on that screen?"


BENEDICT CUMBERBATCH: "I always get incredibly nervous, especially on an empty stomach having only had a macchiato. It makes your heart beat a lot faster and I don't like it. I look away when it's me, I don't like being my own audience. It's very weird. ... You probably saw my nostril hairs, counted how many pores I've got on my nose and which one of my teeth is wonky. "


AP: "It's obviously in the great tradition of having an English baddie."


CUMBERBATCH: "I'm following in the very hallowed footsteps of (Jeremy) Irons, (Alan) Rickman and Tom Hiddleston, my great friend in this summer's "Avengers." There are a few of us who have done it before, it stretches back as old as time. They get excited about these actors with theatre training who can do stuff. It's hugely flattering but you're not going to see me do a whole raft of villains after this."


AP: "Congratulations on the Golden Globe nomination (best actor in a miniseries for "Sherlock"). Did you celebrate?"


CUMBERBATCH: "I went out with my niece, who is my PA (personal assistant) Emily, and we got papped (followed by paparazzi) to the point that I couldn't actually see and I had to put my head down and just blink a couple of times. I was trying to get in the car with her and so immediately they presume, 'ah, beautiful blonde.' Poor girl, she's never experienced that before — I've never experienced that — like 15 of them hanging off the bonnet of the car."


AP: "Surely it's only going to get worse after this "Star Trek" film?"


CUMBERBATCH: "I hope not. I don't court it. I think you have to be in certain places at certain times. Of course, promoting a film you're out in the public and I'm proud to do that for the work I've done. But I'm quite a private person at heart."


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Fewer health care options for illegal immigrants

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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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U.S. to send missiles, troops to Turkey

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INCIRLIK AIR BASE, Turkey (Reuters) - U.S. Defense Secretary Leon Panetta signed an order on Friday to send two Patriot missile batteries to Turkey with 400 American personnel to operate them, in a move by NATO members to bolster Turkey's defenses against the threat of Syrian missiles.


The order was signed shortly before Panetta arrived on an unannounced visit to Turkey to meet American troops stationed at the Incirlik Air Base, the last stop on a week-long trip that took him to Afghanistan and Kuwait.


"The purpose of this deployment is to signal very strongly that the United States, working closely with our NATO allies, is going to support the defense of Turkey, especially with potential threats emanating from Syria," spokesman George Little said.


NATO-member Turkey has repeatedly scrambled jets along the countries' joint frontier and responded in kind when shells from the Syrian conflict came down inside its borders, fanning fears that the civil war could spread to destabilize the region.


The widely expected U.S. move follows similar steps by Germany and the Netherlands, which also said they will send two Patriot batteries. The three countries are the only NATO nations with the most modern type of Patriots.


Little declined to say where the U.S. batteries would be located and said the systems would be deployed to Turkey for an unspecified amount of time.


"We expect them to be deployed in the coming weeks," Little said.


NATO approved Turkey's request for air defense batteries on December 4, in a move meant to calm its fears of coming under missile attack, possibly with chemical weapons, from Syria.


The Patriot system is designed to intercept aircraft or missiles. NATO says the measure is purely defensive, but Russia, Syria and Iran have criticized the decision, saying it increases regional instability.


(Reporting by Phil Stewart; Editing by Nick Tattersall; Editing by Janet Lawrence)



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Afghan suicide bomber wounds 14 in Kandahar attack

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KANDAHAR, Afghanistan (AP) — An Afghan official says a suicide bomber on a motorcycle has wounded three NATO troops and 11 civilians in an attack against the main gate of Kandahar Airfield, the main U.S. military base in the south.


Javeed Faisal, who is a spokesman for the provincial governor, said the attack took place just after nightfall Thursday and targeted the gate that provides access to the military side of the city's airport.


Suicide attacks are not uncommon in Kandahar, the birthplace of the Taliban.


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BEVERLY HILLS, Calif. (AP) — Steven Spielberg is bringing new glory to Abraham Lincoln.


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Tied for second-place Wednesday with five nominations, including best drama are the Iran hostage-crisis thriller "Argo" and the slave-turned-bounty-hunter tale "Django Unchained."


Other best-drama nominees are the shipwreck story "Life of Pi" and the Osama bin Laden manhunt thriller "Zero Dark Thirty."


Nominated for best musical or comedy were: the British retiree adventure "The Best Exotic Marigold Hotel"; the Victor Hugo musical "Les Miserables"; the first-love tale "Moonrise Kingdom"; the fishing romance "Salmon Fishing in the Yemen"; and the lost-soul romance "Silver Linings Playbook.


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