Government can help in training of foreign workers: SNEF

SINGAPORE: The Singapore National Employers Federation (SNEF) says the government can help in defraying the cost of training foreign workers.

In an interview with MediaCorp, SNEF president Stephen Lee said the federation is in discussions with various agencies to see how this can be done.

Mr Lee pointed out that the productivity of foreign workers must be raised in order for Singapore to achieve its long term productivity target of 2 to 3 per cent.

To recruit better skilled workers, the federation says a few industries are working with the authorities to implement a stricter pre-selection process where workers are tested for their skills before they arrive in Singapore.

Construction workers like Umesh Sundaram survives on less than S$300 a month. He earns about S$1,100 a month and sends most of it to his family in India.

The 25-year-old hopes he can earn more as his skills improves.

"I'd like to go for training to be more productive, so it can increase my salary," said Umesh.

The Workforce Development Agency (WDA) tells MediaCorp that only a small number of foreign workers are sent for training by their companies.

Mr Lee said foreign workers, who represent one third of the workforce, cannot be neglected.

"We must have some programmes to train foreign workers. Those who are already here, (we can) re-train them, to upgrade their skills...the more sensitive question is: who will take up the tab for this training?" he said.

"We are in discussions with various agencies to see how they can do that without putting undue burden on the government's training expenses," he added.

The government currently does not provide direct training subsidies for foreign workers.

Labour chief Lim Swee Say pointed out that employers are ultimately responsible for improving the productivity of migrant workers.

"The ownership of upgrading every worker cannot be with the government, or the tripartite partners, it has to be with the management," he said.

Observers noted that some companies hire foreign workers on short-term contracts, which reduce the incentive to send them for training.

However they pointed out that there were many reasons to train workers who stay with the company longer; HR experts believe foreign workers will be able to earn more when their productivity increases and can take on greater responsibilities.

"Cost is always a major consideration for any business and if the company has to come out with additional cost to train these foreign workers and with very minimal productivity gains, then it won't be (much of an incentive)," said Ronald Lee, managing director of PrimeStaff Management Services.

"However, if the government does come by and also support and provide finances to supplement this training, then it will be easier to incentivise the employers to provide more training," he said.

- CNA/jc

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We have to forget that India and Pakistan are enemies. We are not forgetting 26/11: Rehman Malik

Pakistan's interior minister Rehman Malik, who flown back on Sunday, thinks both the countries have moved much beyond merely sharing 'dossiers' on fugitives and key 26\11 accused. He says a lot of investigation has been done at Islamabad's end which could soon see conviction of the conspirators. During his short visit of less than 48 hours, he had not only ruffled many feathers by touching usual 'irritants' but also extended his wish-lists which he considers important for carrying forward friendly relationship. He wants India to do away with 'police reporting' clause in visa system. In an interview to TOI, he expressed his desire for a kind of relationship where citizens from both sides can even travel across the border (Wagah\Attari) in their private cars having smart cards and GPRS system to certain restricted areas.

Excerpts:

Q. Both the countries had signed the new visa agreement over three months ago. India was ready to implement it in October. What is the reason for this delay in implementing it from Pakistan's side? How will the liberalized visa system be beneficial?

A. Even we were eager to implement it quickly. I had to come (for the launch of the agreement) but I could not come earlier. Secondly, if you are going to implement certain agreement, you have to set up a mechanism for this. I wanted to approve registered travel agents under ITTA (International Travel and Tourist Agency) guidelines as I did not want to face the charge of favouring certain operators. All these took time. The new visa regime will increase people-to-people contact which is a prerequisite to remove misunderstandings.

Q. What other steps you think are important to facilitate more people-to-people contract and travel to each other's country?

A. As a next step, I have even suggested during meetings that we should even do away with the system of 'police reporting' clause in visa. I don't think it is important to carry on with such a system in this electronic age where tracking of each-other nationals through computerized immigration checking system has become much easier. There is a suggestion from my side that we should reach a point where citizens from both sides can even travel across the border (Wagah\Attari) in their private cars having smart (security) cards and GPRS system to certain restricted areas.

Q. Your remark that both the countries should forget the past and move on to bring an era of peace and friendship for future generations is appreciated but at the same time it also raises a question whether Pakistan only wants to forget 26\11 and Kargil. Why can't it move further back in the past and forget Kashmir and UN resolution on it?

A. We have to forget that India and Pakistan are enemies. We are converging on Kashmir. It is a part of composite dialogue between the two countries. We are not forgetting 26/11. I never said forget the incidents. I said forget feeling of animosity. Let's create an era of brightness. I have found great hope between people of both the countries. Incidents are happening because we were not every close.

Q. There doesn't appear to be any progress on the ground despite promises made by Pakistan on anti-terror measures. How can you expect progress in other fields?

A. How many things have happened after Bombay blasts (Mumbai terror attack)? Whenever India has said it suspected some area we have searched and even shared information. Intelligence to intelligence, ministry to ministry, government to government...everybody is interacting. With interaction comes friendship. All incidents that are happening can be averted with friendship. You are spending millions we are spending millions (on security). We have to fight poverty and extremism. At government level, we have done many things. Now people-to people contact will clear misunderstandings. We have created a situation for this now.

Q. People keep hearing about dossier on Hafiz Saeed (LeT chief and one of the key 26\11 conspirators). Pakistan appears to be reluctant to get to the bottom of the conspiracy behind the terror attack specifically when all evidence are there on Pakistani soil. Why there is no progress?

A. We have move quite a far from dossier. We have done investigation which even your agencies have appreciated. We have done the investigation and submitted it to our Court where the trial is going on. The Court had formed the Judicial Commission. I have to follow my Court. My Court says until and unless and I repeat until and unless the witnesses are cross-examined they cannot proceed further. I can say with certainty that the trial would have been completed by now if the Judicial Commission from Pakistan had been allowed to cross-examine the four crucial Indian witnesses in the Mumbai attack case when it had visited India (in March, 2012). With the Indian government agreeing to let in the Commission visit Mumbai and cross-examine the witnesses "very soon", the trial in Pakistan (of Lashkar commander Zaki-ur-Rahman Lakhvi and six other accused) would be concluded swiftly.

Q. You must have discussed these issues when you met Indian delegation here. Would you please spell out those details?

A. I have discussed many things and raised certain issues. I told them that India should share all the details of investigation done at its end...Abu Jundal (who had coordinated the Mumbai terror strikes of Ajmal Kasab and nine other Laskhar terrorists from the Karachi control room) is an Indian. We are also curious as to how he and others landed in Pakistan. He was a known criminal. He worked as a source of an Indian intelligence agency. I am not saying this. He himself has said so. I have seen records...We have to figure out all these...whether non-state actors from the two sides are acting at the instance of a third power. You are aware that things had taken an alarming turn, with both countries massing their troops on the border. Things would have been worse if the leadership on both sides had not shown maturity.

Q. You remarks on Babri Masjid drew lot of attention. A cross-section of people thinks you shouldn't have raised India's internal matter. Your remarks mentioning 9\11, 26\11, Samjhauta Express blasts and Babri Masjid demolition issue in the same breath created unease even among those who are strongly advocating for peace between the two countries. What you have to say about this?

A. There is no comparison, whatsoever, between Babri mosque demolition and 26/11 attacks. Babri mosque was actually ethnic. It was a sectarian strife... It should not be taken in a negative way. I have no intention to interfere in the inter-faith matter. Pakistan itself is a victim of inter-faith clashes, sectarian strife. There have been Shia-Sunni clashes in Pakistan. My intention was not to create confusion but sound caution to the both countries. I am not a kind of person who would interfere in somebody's religion or inter-faith matters but a person who goes out and leads on issues of communal harmony. So, I said like the incidents of 9/11, people dying in Quetta, our Shia and Sunni people are being killed in Karachi. I (had) also said incidents like Mumbai blasts, Babri Masjid case, I am repeating it here and please do not take it in a negative way, we do not want that these things should happen in any region of India and Pakistan. Religious violence often leads to extremism and every efforts should be made to check it.

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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. Community Mourns Victims of Massacre

President Obama will visit Newtown, Conn. today to meet with the grieving families and thank the first responders from Friday's school shooting, as the community begins the long process of healing.

The pictures of the young victims killed at Sandy Hook Elementary School emerged Saturday, along with a remarkable story of survival.

Twenty children and six adults were killed at the school when shooter Adam Lanza went on a shooting rampage.

Later this evening, the community will gather for an interfaith vigil, where the president is scheduled to address mourners, some from out of state who came to offer help and others, who knew the young victims or their families.

Addressing the nation on Friday, Obama mourned the children who "had their entire lives ahead of them -- birthdays, graduations, weddings, kids of their own."

Story of Survival

READ: Complete List of Sandy Hook Victims

The lone survivor of her class tricked the gunman by playing dead, the girl's pastor told ABC News, before running out of the school covered in the blood of her classmates.

"She ran out of the school building covered from head to toe with blood and the first thing she said to her mom was, 'Mommy, I'm OK but all my friends are dead,'" said Pastor Jim Solomon. "Somehow in that moment, by God's grace, [she] was able to act as she was already deceased."

Five first graders in another class were also killed, along with six staff members.

Connecticut Shooting: Churches Services Honor Victims Watch Video

Connecticut Shooting: Pastor Explains How Girl Played Dead to Survive Watch Video

"The mom told me, and I thought this was very insightful, that she was suffering from what she felt was survivor's guilt because so many of her friends no longer have their children but she has hers," the pastor said.

Click Here for full coverage of the tragedy at the elementary school.

Remembering the Victims of the Sandy Hook Shooting

There was Emilie Parker, the little girl with the blond hair and bright blue eyes, who 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.

Noah Pozner and his twin sister had just celebrated their sixth birthdays. His twin sister survived the shooting, but Noah did not.

Six-year-old Jesse Lewis went to school on Friday, excited to make gingerbread houses. He died, along with his teacher, Victoria Soto, 27, whose family said was shielding some of her first graders when she was hit by bullets.

As the community mourns and families bear the pain of planning 26 funerals before Christmas, school board members hope to get students back to a familiar routine.

"Well, all the mental health experts we've talked to...tell us that the best thing we can do is to get back to normal operations as soon as possible," said Bill Hart, a member of the Newtown Board of Education.

"We know some teachers won't be prepared to come back, he said. "We are going to be prepared with substitutes. We've got counseling for all. We're prepared to do whatever we have to do to help all of our community."

READ: Police Seek Motive in Shooting

Students who attend Sandy Hook Elementary School will be moved to another location that has yet to be announced, Hart said. He said officials did not yet know what would become of the building that was turned into a slaughterhouse on Friday.

"I think trying to understand what we are going to do with that is a long process and we're not in any way prepared to make those decisions now," he said.

ABC News' Lara Spencer and Dan Harris contributed reporting.

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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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US school shooter blasted his way in: governor

 

NEWTOWN, Connecticut: The gunman in the Connecticut school massacre that left 20 small children dead blasted his way through a locked glass door, climbed through and proceeded with his killing spree, the state governor said on Sunday.

"He shot his way into the school. The school was locked. He used a weapon to open up the glass, and then walked in," Governor Dan Malloy said on the ABC program "This Week."

The shooter, Adam Lanza, fired "a number of rounds," Malloy said.

Police had previously said Lanza forced his way into the school but it was not clear if he did it by shooting his way in.

"He discharged to make an opening and then went through it, went to the first classroom, as you know, went to the second classroom," the governor said.

He added that authorities believe that, while shooting in the second classroom, the gunman heard police and emergency crews rushing to the scene of the massacre, Sandy Hook Elementary School, and took his own life.

The overall death toll was 28: the 20 children aged 6 or 7, six adults at the school, Lanza himself and his mother Nancy, whom he shot at her home before heading to the school.

Malloy said the first call for help from the school came from someone who was wounded but survived, and that first responders were swift.

"But, you know, this -- this sick fellow, you know, clearly mentally ill, killed his mother, proceeded to go on and kill a great number of people," Malloy said.

- AFP/xq

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IAEA chief urges 'better communication’ to deal with Kudankulam-like stir

KORIYAMA (FUKUSHIMA): UN nuclear watchdog IAEA chief Yukiya Amano on Saturday called for "better communication and higher transparency" in dealing with Kudankulam-like protests against nuclear power. Even as he sought to distance himself from both sides — protesters as well as votaries of nuclear power —the director-general said that the issue of spent nuclear fuel, which is at the core of protests in India, was one of the lessons the world had learnt from the accident at Fukushima Daiichi nuclear power station in Japan last year.

Amano was talking exclusively to TOI here on the sidelines of the Fukushima ministerial conference that saw many smaller countries pleading for nuclear power generation to deal with rising fossil fuel prices and climate change issues. The conference, which was presided over by Japanese foreign minister Koichiro Gemba, was held to strengthen nuclear safety worldwide.

"I don't have any particular comment on opposition to nuclear power anywhere, or those who support it, but if I can give a recommendation, we need to share both good news and bad news to be able to get a better understanding of the problem," he told TOI, replying to a query about protests in India that have delayed the commissioning of the first unit at Kudankulam.

"Communication is one of the areas where we need to improve and IAEA has been organizing meetings of international experts to look into this. We have to explain complicated things in a simple manner and it is only through better communication and higher transparency that we can achieve this," he added.

Amano admitted that the safety aspect of the spent nuclear fuel was a very important issue. "Let's say it is a lesson we have learnt from the Fukushima accident in which debris fell into spent fuel pools. We are trying to address the issue but it will take time," he said.

The government's 'success' in acquiring reprocessing rights from Russia has actually become a millstone around its neck as this prevents it from sending the spent or used fuel back to Russia. The government painstakingly maintains that it considers spent fuel an asset that is used to produce electricity.

Amano said that ensuring the highest level of safety was not the responsibility of the IAEA but the country which was using the nuclear power. "We can only assist them in achieving that highest level of safety," he said.

"We have safeguards agreements and we implement it. The IAEA standards are not legally binding but I believe these are effective because in the end these are in the interest of each country that has nuclear power," he said. Amano said that the Fukushima accident was not likely to impact the peaceful uses of nuclear power in the manner in which the last accident in Chernobyl did. "You have to remember that 65 nuclear reactors are still under construction all over the world even after Fukushima. There are countries which want to have nuclear power because of the volatile fossil fuel prices and also because of issues related to climate change," 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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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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