As Conn. story unfolds, media struggle with facts


NEW YORK (AP) — The scope and senselessness of the Newtown, Conn., school shooting challenged journalists' ability to do much more than lend, or impose, their presence on the scene.


Pressed with the awful urgency of the story, television, along with other media, fell prey to reporting "facts" that were often in conflict or wrong.


How many people were killed? Which Lanza brother was the shooter: Adam or Ryan? Was their mother, who was among the slain, a teacher at the school?


Like the rest of the news media, television outlets were faced with intense competitive pressures and an audience ravenous for details in an age when the best-available information was seldom as reliable as the networks' high-tech delivery systems.


Here was the normal gestation of an unfolding story. But with wall-to-wall cable coverage and second-by-second Twitter postings, the process of updating and correcting it was visible to every onlooker. And as facts were gathered by authorities, then shared with reporters (often on background), a seemingly higher-than-usual number of points failed to pan out:


— The number of dead was initially reported as anywhere from the high teens to nearly 30. The final count was established Friday afternoon: 20 children and six adults, as well as Lanza's mother and the shooter himself.


— For hours on Friday, the shooter was identified as Ryan Lanza, with his age alternatively reported as 24 or 20. The confusion seemed explainable when a person who had spoken with Ryan Lanza said that 20-year-old Adam Lanza, the shooter who had then killed himself, could have been carrying identification belonging to his 24-year-old sibling.


This case of mistaken identity was painfully reminiscent of the Atlanta Olympics bombing case in 1996, when authorities fingered an innocent man, and the news media ran with it, destroying his life. Such damage was averted in Ryan Lanza's case largely by his public protestations on social media, repeatedly declaring "It wasn't me."


— Initial reports differed as to whether Lanza's mother, Nancy, was shot at the school, where she was said to be a teacher, or at the home she shared with Adam Lanza. By Friday afternoon, it was determined that she had been shot at their home.


Then doubts arose about whether Nancy Lanza had any link to Sandy Hook Elementary. At least one parent said she was a substitute teacher, but by early Saturday, an official said investigators had been unable to establish any connection with the school.


That seemed to make the massacre even more confusing. Early on, the attack was said to have taken place in her own classroom and was interpreted by more than one on-air analyst as possibly a way for Adam Lanza to strike back at children with whom he felt rivalry for his mother's affection.


— At first, authorities said Lanza had used two pistols (a Glock and a Sig Sauer) in the attack and left a .223-caliber Bushmaster rifle in the trunk of a vehicle. But by Saturday afternoon, the latest information was that all the victims had been shot with the rifle at close range.


— There were numerous versions of what Lanza was wearing, including camouflage attire and black paramilitary garb.


With so many unanswered questions, TV correspondents were left to set the scene and to convey the impact in words that continually failed them.


However apt, the phrase "parents' worst nightmare" became an instant cliche.


And the word "unimaginable" was used countless times. But "imagine" was exactly what the horrified audience was helpless not to do.


The screen was mostly occupied by grim or tearful faces, sparing everybody besides law enforcement officials the most chilling sight: the death scene in the school, where — as viewers were reminded over and over — the bodies remained while evidence was gathered. But who could keep from imagining it?


Ironically, perhaps the most powerful video came from 300 miles away, in Washington, where President Barack Obama delivered brief remarks about the tragedy. His somber face, the flat tone of his voice, the tears he daubed from his eyes, and his long, tormented pauses said as much as his heartfelt words. He seemed to speak for everyone who heard them.


The Associated Press was also caught in the swirl of imprecise information. When key elements of the story changed, the AP issued two advisories — one to correct that Adam Lanza, not his brother, was the gunman, and another that called into question the original report that Lanza's mother taught at the school.


But TV had hours to fill.


Children from the school were interviewed. It was a questionable decision for which the networks took heat from media critics and viewers alike. But the decision lay more in the hands of the willing parents (who were present), and there was value in hearing what these tiny witnesses had to say.


"We had to lock our doors so the animal couldn't get in," said one little boy, his words painting a haunting picture.


In the absence of hard facts, speculation was a regular fallback. Correspondents and other "experts" persisted in diagnosing the shooter, a man none of them had ever met or even heard of until hours earlier.


CNN's "Piers Morgan Tonight" scored an interview with a former classmate of Lanza's — with an emphasis on "former."


"I really only knew him closely when we were very, very young, in elementary school together," she said.


Determined to unlock Lanza's personality, Morgan asked the woman if she "could have ever predicted that he would one day flip and do something as monstrous as this?"


"I don't know if I could have predicted it," she replied, struggling to give Morgan what he wanted. "I mean, there was something 'off' about him."


The larger implications of the tragedy were broached throughout the coverage — not least by Obama.


"We're going to have to come together and take meaningful action to prevent more tragedies like this, regardless of the politics," he said, which may have gladdened proponents of stricter gun laws.


But CBS correspondent Nancy Cordes noted, "There's often an assumption that after a horrific event like this, it will spark a fierce debate on the issue. But in recent years, that hasn't been the case."


Appearing on "The O'Reilly Factor" Friday night, Fox News correspondent Geraldo Rivera voiced his own solution.


"I want an armed cop at every school," he said.


___


EDITOR'S NOTE — Frazier Moore is a national television columnist for The Associated Press. He can be reached at fmoore(at)ap.org and at http://www.twitter.com/tvfrazier .


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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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Sandy Hook shooter a mystery to neighbors and former classmates


Police prohibited access on Saturday to the neighborhood where gunman Adam Lanza lived. (Jason Sickles/Yahoo N …


NEWTOWN, CONN. -- Even to his neighbors, the gunman who massacred 26 kids and educators at an elementary school here still remains somewhat of a mystery.


"I want to know more," said Len Strocchia, who lives less than half mile away from the shooter's house.


Authorities say Adam Lanza, 20, killed his mother, Nancy Lanza, at their well-to-do home Friday morning before driving to Sandy Hook Elementary where he stormed in and committed one of the worst mass school shootings in U.S. history. The victims were 20 first-graders and six staffers, including the principal.


Adam Lanza's parents divorced a few years ago. Messages left with his father, Peter Lanza, were not returned.


On Saturday, Strocchia walked down the street to see the shooter's house firsthand, but was forbidden to go past a police barricade near the Lanza home.


"I want to know which house and why I didn't know them," the father of two teenagers told Yahoo News.


Another neighbor did know Adam Lanza. Megan, who declined to give her last name, was a classmate of the shooter from kindergarten through middle school.


"He wasn't like a weird kid as a child," Megan told Yahoo News. "He was just quiet. He didn't put off a friendly vibe."


But she said he was one of the smartest students in school.


"He was always participating in class and everything," Megan said.


But she said her former classmate with whom she rode the school bus sort of vanished after their junior high years.


"He almost fell off the radar in middle school," Megan told Yahoo News.


The shooter's aunt, Marsha Lanza, told ABC News that his mother pulled him out of Newtown public schools because of a dispute over the district's plan for her son.


"She mentioned she wound up home-schooling him because she battled with the school district," the aunt told ABC News.


Police said Adam Lanza, dressed in all black, was armed with two handguns and a semi-automatic Bushmaster .223 rifle when he barged into the school.


Dr. Carver, the medical examiner, said it appears that all the children where gunned down by the military-style rifle. Authorities said all the weapons were legally owned and registered by Nancy Lanza, the shooter's mother.


Newtown school superintendent Janet Robinson told reporters Saturday that Nancy Lanza had no connection to Sandy Hook school, despite initial reports Lanza was on the faculty or a substitute teacher there.


"I'm sickened that this mass murder was done with legal guns," said Strocchia, the neighbor. "I'd like to find out why. Why did she have guns?"


But acquaintances of Nancy Lanza told The New York Times that the 52-year-old mother was a big fan of guns.


"She had several different guns," Dan Holmes told the newspaper. "I don't know how many. She would go target shooting with her kids."


Reports that Adam Lanza may have suffered from a personality disorder are being supported by people who knew the mother to have a troubled son.


According to the Times story, a friend said Nancy Lanza was "handling a very difficult situation with uncommon grace."


Investigators revealed on Saturday that evidence found in the Lanza might provide a possible motive for the massacre.


State police spokesman Lt. Paul Vance declined to provide specifics about the evidence but said, "we're hopeful it will paint a complete picture."


Neighbors like Strocchia are searching for answers too. However, he said, said he harbors no anger.


"I'm thankful my children are alive," he said. "I have compassion and mercy. There was something wrong with him."



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NKorea rocket launch shows young leader as gambler


PYONGYANG, North Korea (AP) — A triumphant North Korea staged a mass rally of soldiers and civilians Friday to glorify the country's young ruler, who took a big gamble this week in sending a satellite into orbit in defiance of international warnings.


Wednesday's rocket launch came just eight months after a similar attempt ended in an embarrassing public failure, and just under a year after Kim Jong Un inherited power following his father's death.


The surprising success of the launch may have earned Kim global condemnation, but at home the gamble paid off, at least in the short term. To his people, it made the 20-something Kim appear powerful, capable and determined in the face of foreign adversaries.


Tens of thousands of North Koreans, packed into snowy Kim Il Sung Square, clenched their fists in a unified show of resolve as a military band tooted horns and pounded on drums.


Huge red banners positioned in the square called on North Koreans to defend Kim Jong Un with their lives. They also paid homage to Kim Jong Un's father, Kim Jong Il, and his grandfather, North Korean founder Kim Il Sung.


Pyongyang says the rocket put a crop and weather monitoring satellite into orbit. Much of the rest of the world sees it as a thinly disguised test of banned long-range missile technology. It could bring a fresh round of U.N. sanctions that would increase his country's international isolation. At the same time, the success of the launch could strengthen North Korea's military, the only entity that poses a potential threat to Kim's rule.


The launch's success, 14 years after North Korea's first attempt, shows more than a little of the gambling spirit in the third Kim to rule North Korea since it became a country in 1948.


"North Korean officials will long be touting Kim Jong Un as a gutsy leader" who commanded the rocket launch despite being new to the job and young, said Kim Byung-ro, a North Korea specialist at Seoul National University in South Korea.


The propaganda machinery churned into action early Friday, with state media detailing how Kim Jong Un issued the order to fire off the rocket just days after scientists fretted over technical issues, ignoring the chorus of warnings from Washington to Moscow against a move likely to invite more sanctions.


Top officials followed Kim in shrugging off international condemnation.


Workers' Party Secretary Kim Ki Nam told the crowd, bundled up against a winter chill in the heart of the capital, that "hostile forces" had dubbed the launch a missile test. He rejected the claim and called on North Koreans to stand their ground against the "cunning" critics.


North Korea called the satellite a gift to Kim Jong Il, who is said to have set the lofty goal of getting a satellite into space and then tapped his son to see it into fruition. The satellite, which North Korean scientists say is designed to send back data about crops and weather, was named Kwangmyongsong, or "Lode Star" — the nickname legendarily given to the elder Kim at birth.


Kim Jong Il died on Dec. 17, 2011, so to North Koreans, the successful launch is a tribute. State TV have been replaying video of the launch to "Song of Gen. Kim Jong Il."


But it is the son who will bask in the glory, and face the international censure that may follow.


Even while he was being groomed to succeed his father, Kim Jong Un had been portrayed as championing science and technology as a way to lift North Korea out of decades of economic hardship.


"It makes me happy that our satellite is flying in space," Pyongyang citizen Jong Sun Hui said as Friday's ceremony came to a close and tens of thousands rushed into the streets, many linking arms as they went.


"The satellite launch demonstrated our strong power and the might of our science and technology once again," she told The Associated Press. "And it also clearly testifies that a thriving nation is in our near future."


Aside from winning him support from the people, the success of the launch helps his image as he works to consolidate power over a government crammed with elderly, old-school lieutenants of his father and grandfather, foreign analysts said.


Experts say that what is unclear, however, is whether Kim will continue to smoothly solidify power, steering clear of friction with the powerful military while dealing with the strong possibility of more crushing sanctions. The United Nations says North Korea already has a serious hunger problem.


"Certainly in the short run, this is an enormous boost to his prestige," according to Marcus Noland, a North Korea analyst at the Peterson Institute for International Economics in Washington.


Noland, however, also mentioned the "Machiavellian argument" that this could cause future problems for Kim by significantly boosting the power of the military — "the only real threat to his rule."


Successfully firing a rocket was so politically crucial for Kim at the onset of his rule that he allowed an April launch to go through even though it resulted in the collapse of a nascent food-aid-for-nuclear-freeze deal with the United States, said North Korea analyst Kim Yeon-su of Korea National Defense University in Seoul.


The launch success consolidates his image as heir to his father's legacy. But it could end up deepening North Korea's political and economic isolation, he said.


On Friday, the section at the rally reserved for foreign diplomats was noticeably sparse. U.N. officials and some European envoys stayed away from the celebration, as they did in April after the last launch.


Despite the success, experts say North Korea is years from even having a shot at developing reliable missiles that could bombard the American mainland and other distant targets.


North Korea will need larger and more dependable missiles, and more advanced nuclear weapons, to threaten U.S. shores, though it already poses a shorter-range missile threat to its neighbors.


The next big question is how the outside world will punish Pyongyang — and try to steer North Korea from what could come next: a nuclear test. In 2009, the North conducted an atomic explosion just weeks after a rocket launch.


Scott Snyder, a Korea specialist for the Council on Foreign Relations, wrote recently that North Korea's nuclear ambitions should inspire the U.S., China, South Korea and Japan to put aside their issues and focus on dealing with Pyongyang.


If there is a common threat that should galvanize regional cooperation, "it most certainly should be the prospect of a 30-year-old leader of a terrorized population with his finger on a nuclear trigger," Snyder said.


____


Jon Chol Jin in Pyongyang, and Foster Klug and Sam Kim in Seoul, South Korea, contributed to this report. Follow Jean H. Lee on Twitter: (at)newsjean.


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Owner of Rivera plane being investigated by DEA


PHOENIX (AP) — The company that owns a luxury jet that crashed and killed Latin music star Jenni Rivera is under investigation by the U.S. Drug Enforcement Administration, and the agency seized two of its planes earlier this year as part of the ongoing probe.


DEA spokeswoman Lisa Webb Johnson confirmed Thursday the planes owned by Las Vegas-based Starwood Management were seized in Texas and Arizona, but she declined to discuss details of the case. The agency also has subpoenaed all the company's records, including any correspondence it has had with a former Tijuana mayor who U.S. law enforcement officials have long suspected has ties to organized crime.


The man widely believed to be behind the aviation company is an ex-convict named Christian Esquino, 50, who has a long and checkered legal past. Corporate records list his sister-in-law as the company's only officer, but insurance companies that cover some of the firm's planes say in court documents that the woman is merely a front and that Esquino is the one in charge.


Esquino's legal woes date back decades. He pleaded guilty to a fraud charge that stemmed from a major drug investigation in Florida in the early 1990s and most recently was sentenced to two years in federal prison in a California aviation fraud case. Esquino, a Mexican citizen, was deported upon his release. Esquino and various other companies he has either been involved with or owns have also been sued for failing to pay millions of dollars in loans, according to court records.


The 43-year-old California-born Rivera died at the peak of her career when the plane she was traveling in nose-dived into the ground while flying from the northern Mexican city of Monterrey to the central city of Toluca early Sunday morning. She was perhaps the most successful female singer in grupero, a male-dominated Mexico regional style, and had branched out into acting and reality television.


It remained unclear Thursday exactly what caused the crash and why Rivera was on Esquino's plane. The 78-year-old pilot and five other people were also killed. Esquino was not on the plane.


The late singer's brother, Pedro Rivera Jr., said that he didn't know anything about the owner or why or how she ended up in his plane.


Esquino told the Los Angeles Times in a telephone interview from Mexico City earlier this week that the singer was considering buying the aircraft from Starwood for $250,000 and the flight was offered as a test ride. He disputed reports that he owns Starwood, maintaining that he is merely the company's operations manager "with the expertise."


In response to an email from The Associated Press, Esquino said he did not want to comment. Calls to various phone numbers associated with him rang unanswered.


Esquino is no stranger to tangles with the law. He was indicted in the early 1990s along with 12 other defendants in a major federal drug investigation that claimed the suspects planned to sell more than 480 kilograms of cocaine, according to court records. He eventually pleaded guilty to conspiring to conceal money from the IRS and was sentenced to five years in prison, but much of the term was suspended for reasons that weren't immediately clear.


He served about five months in prison before being released.


Cynthia Hawkins, a former assistant U.S. attorney who handled the case and is now in private practice in Orlando, remembered the investigation well.


"It was huge," Hawkins said Thursday. "This was an international smuggling group."


She said the case began with the arrest of Robert Castoro, who was at the time considered one of the most prolific smugglers of marijuana and cocaine into Florida from direct ties to Colombian drug cartels in the 1980s. Castoro was convicted in 1988 and sentenced to life in prison, but he then began cooperating with authorities, leading to his sentence being reduced to just 10 years, Hawkins said.


"Castoro cooperated for years," she said. "We put hundreds of people in jail."


He eventually gave up another smuggler, Damian Tedone, who was indicted in the early 1990s along with Esquino and 11 others in a conspiracy involving drug smuggling in Florida in the 1980s at a time when the state was the epicenter of the nation's cocaine trade.


Tedone also cooperated with authorities and has since been released from prison. Telephone messages left Thursday for both Tedone and Castoro were not returned.


Esquino eventually pleaded guilty to the lesser offense of concealing money from the IRS.


Joseph Milchen, Esquino's attorney at the time, said Thursday the case eventually revolved around his client "bringing money into the United States without declaring it."


However, Milchen acknowledged that a plane purchased by Esquino was "used to smuggle drugs."


He denied his former client has ever had anything to do with illegal narcotics.


"The only thing he has ever done is with airplanes," Milchen said.


Court filings also indicate Esquino was sentenced to two years in federal prison after pleading guilty in 2004 to committing fraud involving aircraft he purchased in Mexico, then falsified the planes' log books and re-sold them in the United States.


Also in 2004, a federal judge ordered him and one of his companies to pay a creditor $6.2 million after being accused of failing to pay debts to a bank.


As the years passed, Esquino's troubles only grew.


In February this year, a Gulfstream G-1159A plane the government valued at $500,000 was seized by the U.S. Marshals Service on behalf of the DEA after landing in Tucson on a flight that originated in Mexico


Four months later, the DEA subpoenaed all of Starwood's records dating to Dec. 13, 2007, including federal and state income tax documents, bank deposit information, records on all company assets and sales, and the entity's relationship with Esquino and more than a dozen companies and individuals, including former Tijuana Mayor Jorge Hank-Rhon, a gambling mogul and a member of one of Mexico's most powerful families. U.S. law enforcement officials have long suspected Hank-Rhon is tied to organized crime but no allegations have been proven. He has consistently denied any criminal involvement.


He was arrested in Mexico last year on weapons charges and on suspicion of ordering the murder of his son's former girlfriend. He was later freed for lack of evidence.


The subpoena was obtained by the U-T San Diego newspaper.


A Starwood attorney listed on the subpoena, Jeremy Schuster, declined Thursday to provide details.


"We don't comment on matters involving clients," he said.


In September, the DEA seized another Starwood plane — a 1977 Hawker 700 with an insured value of $1 million — after it landed in McAllen, Texas, from a flight from Mexico.


Insurers of both aircraft have since filed complaints in federal court in Nevada seeking to have the Starwood policies nullified, in part, because they say Esquino lied in the application process when he noted he had never been indicted on drug-related criminal charges. Both companies said they would not have issued the policies had he been truthful.


Another attorney for Starwood has not responded to phone and email messages seeking comment, and no one was at the address listed at its Las Vegas headquarters. The address is a post office box in a shipping and mailing store located between a tuxedo rental shop and a supermarket in a shopping center several miles west of the Las Vegas Strip.


___


Associated Press writers Elliot Spagat in San Diego and Ken Ritter in Las Vegas contributed to this report.


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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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20 children, 6 adults killed at Conn. school shooting



Twenty children died today when a heavily armed man invaded a Newtown,
Conn., elementary school and sprayed staff and students with bullets.



The gunman, identified as Adam Lanza, 20, 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 were also slain, bringing the total to
26.



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 bullet proof
vest.



Lanza drove to Sandy Hook Elementary School and continued his rampage,
killing 26 people, authorities said. He was found dead at the school. It
appears that he died from what is believed to be a self inflicted
gunshot wound. The rifle was found in his car.



In the early confusion surrounding the investigation, federal sources
initially identified the suspect as Adam's older brother Ryan Lanza, 24.
He is being questioned by police.



LIVE UPDATES: Newtown, Conn., School Shooting



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



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 there's "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.



CLICK HERE for more photos from the scene.



The alert at the school ended when Vance announced, "The shooter is deceased inside the building. The public is not in danger."



The massacre prompted the town of Newtown to lock down all its schools
and draw SWAT teams to the school, authorities said today. Authorities
initially believed that there were two gunmen and were searching cars
around the school, but authorities do not appear to be looking for
another gunman.



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. Today's carnage exceeds the 1999
Columbine High School shooting in which 13 died and 24 were injured.



The Newtown shooting comes three days after masked gunman Jacob Roberts
opened fire in a busy Oregon mall, killing two before turning the gun
on himself.



Today's 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.



State Police received the first 911 call at 9:41 a.m. and immediately
began sending emergency units from the western part of the state.
Initial 911 calls stated that multiple students were trapped in a
classroom, possibly with a gunman, according to a Connecticut State
Police source.



Lt. Paul Vance said that on-duty and off-duty officers swarmed to the
school and quickly checked "every door, every crack, every crevice" in
the building looking for the gunman and evacuating children.



A photo from the scene shows a line of distressed children being led out of the school.



Three patients have been taken to Danbury Hospital, which is also on lockdown, according to the hospital's Facebook page.



"Out of abundance of caution and not because of any direct threat
Danbury Hospital is under lockdown," the statement said. "This allows us
simply to focus on the important work at hand."



Newtown Public School District secretary of superintendent Kathy June
said in a statement that the district's schools were locked down because
of the report of a shooting. "The district is taking preventive
measures by putting all schools in lockdown until we ensure the safety
of all students and staff," she said.



State police sent SWAT team units to Newtown.



All public and private schools in the town were on lockdown.



"We have increased our police presence at all Danbury Public Schools due
to the events in Newtown. Pray for the victims," Newtown Mayor Boughton
tweeted.



State emergency management officials said ambulances and other units were also en route and staging near the school.



A message on the school district website says that all afternoon
kindergarten is cancelled today and there will be no midday bus runs.




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Afghan suicide bomber kills US soldier, 2 Afghans


KANDAHAR, Afghanistan (AP) — A Taliban suicide car bomber killed one American soldier and two Afghan civilians Thursday near a U.S. military base shortly after the visiting U.S. defense secretary left the facility in southern Afghanistan, officials said.


The attacker targeted a moving vehicle near the access gate to the military side of Kandahar's airport, according to Afghan Defense Ministry spokesman Gen. Mohammad Zahir Azimi.


It was unclear whether the blast had anything to do with U.S. Defense Secretary Leon Panetta's unannounced visit to Kandahar Air Field earlier Thursday. The sprawling facility houses more than 20,000 service members from 20 countries and has more than 11,000 civilian contract workers.


Panetta said one American soldier was killed and three others wounded. Azimi said two Afghan civilians were killed and 14 wounded.


Taliban spokesman Qari Yousef Ahmadi claimed responsibility for the attack in an email, saying a suicide car bomber had targeted foreign military vehicles that were stopped near the gate of Kandahar Air Field.


Panetta was at the air field for about three hours, receiving a briefing from U.S. Army Maj. Gen. Robert Abrams, the region's top coalition commander. Panetta also spoke to about 350 U.S. troops and took questions from them before flying back to Kabul.


Panetta's press secretary George Little confirmed the suicide car bombing occurred, adding that coalition officials were assessing the situation. "I have no information at this time that this incident was associated with the visit of the secretary of defense. The attack occurred after the secretary returned to Kabul," he said.


A U.S. official said early indications were that the attacker did not breach the base's perimeter. The official spoke on condition of anonymity because the matter was in the early stages of investigation.


Earlier, Ahmad Javed Faisal, spokesman for the governor of Kandahar province, said the attack occurred after dusk and was carried out by a bomber on a motorcycle. There often are conflicting reports in the immediate aftermath of attacks.


___


Associated Press writers Robert Burns and Amir Shah contributed to this report from Kabul.


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Documents: Prisoner plotted to kill Justin Bieber


ALBUQUERQUE, N.M. (AP) — An imprisoned man whose infatuation with Justin Bieber included a tattoo of the pop star on his leg has told investigators in New Mexico he hatched a plot to kill the singer, according to documents recently filed in a New Mexico court.


An affidavit filed in Las Cruces said Dana Martin told investigators he persuaded a man he met in prison and the man's nephew to kill Bieber, along with Bieber's personal bodyguard and two others not connected to the pop star.


The plot contained several gruesome details. Investigators say the plotters wanted to castrate two of the victims with hedge clippers before traveling to New York City to find Bieber. The targets of the castration plot were not connected to Bieber, authorities say, and it doesn't appear that the pop singer was ever in immediate danger of falling victim to the plot.


Martin, a Vermont man who is serving two life sentences for the 2000 killing of a 15-year-old girl, said he was angry at Bieber because he didn't respond to any of his letters. "This perceived slight made Mr. Martin upset and that, coupled with Mr. Martin's perception of being a 'nobody' in prison, led him to begin plotting the kidnap and murder of Victim 3," court documents said.


The documents identified Victim 3 as "J.B.," which New Mexico State Police spokesman Lt. Robert McDonald later confirmed was Justin Bieber.


Martin told investigators that Mark Staake and Tanner D. Ruane headed from New Mexico to the East Coast, planning to be near a Bieber concert scheduled in New York City after killing and castrating two others. They missed a turn and crossed into Canada from Vermont. Staake was arrested on an outstanding warrant. Ruane was arrested later.


Court documents say Martin told investigators that Bieber was the "ultimate target."


New York State Police said Thursday that troopers recovered tools and documents associated with the conspiracy while executing a search warrant on Ruane's vehicle. Among the items found by troopers were a "hand-written drawing of a depiction of Justin Bieber."


Staake, 41, of Albuquerque, has been charged with two counts each of conspiracy to commit first-degree murder and conspiracy to commit aggravated battery with a deadly weapon in connection to the plan.


Ruane, 23, Staake's nephew, also is facing multiple charges related to the plot.


Clinton Norris, of the New Mexico State Police investigations bureau in Las Cruces, said in an affidavit that Martin instructed the suspects to strangle the two first intended targets with paisley neckties, the same kind used in his 2000 murder case. The documents do not give details on how they were to kill Bieber.


McDonald declined to say if any of the murder charges are linked to Bieber. "That is part of the ongoing investigation," he said.


Bieber's management issued a statement that said, "we take every precaution to protect and insure the safety of Justin and his fans."


It was not immediately known if the suspects had defense lawyers.


___


Follow Russell Contreras on Twitter at http://twitter.com/russcontreras


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Study: People worldwide living longer, but sicker


LONDON (AP) — Nearly everywhere around the world, people are living longer and fewer children are dying. But increasingly, people are grappling with the diseases and disabilities of modern life, according to the most expansive global look so far at life expectancy and the biggest health threats.


The last comprehensive study was in 1990 and the top health problem then was the death of children under 5 — more than 10 million each year. Since then, campaigns to vaccinate kids against diseases like polio and measles have reduced the number of children dying to about 7 million.


Malnutrition was once the main health threat for children. Now, everywhere except Africa, they are much more likely to overeat than to starve.


With more children surviving, chronic illnesses and disabilities that strike later in life are taking a bigger toll, the research said. High blood pressure has become the leading health risk worldwide, followed by smoking and alcohol.


"The biggest contributor to the global health burden isn't premature (deaths), but chronic diseases, injuries, mental health conditions and all the bone and joint diseases," said one of the study leaders, Christopher Murray, director of the Institute of Health Metrics and Evaluation at the University of Washington.


In developed countries, such conditions now account for more than half of the health problems, fueled by an aging population. While life expectancy is climbing nearly everywhere, so too are the number of years people will live with things like vision or hearing loss and mental health issues like depression.


The research appears in seven papers published online Thursday by the journal Lancet. More than 480 researchers in 50 countries gathered data up to 2010 from surveys, censuses and past studies. They used statistical modeling to fill in the gaps for countries with little information. The series was mainly paid for by the Bill & Melinda Gates Foundation.


As in 1990, Japan topped the life expectancy list in 2010, with 79 for men and 86 for women. In the U.S. that year, life expectancy for men was 76 and for women, 81.


The research found wide variations in what's killing people around the world. Some of the most striking findings highlighted by the researchers: — Homicide is the No. 3 killer of men in Latin America; it ranks 20th worldwide. In the U.S., it is the 21st cause of death in men, and in Western Europe, 57th.


— While suicide ranks globally as the 21st leading killer, it is as high as the ninth top cause of death in women across Asia's "suicide belt," from India to China. Suicide ranks 14th in North America and 15th in Western Europe.


— In people aged 15-49, diabetes is a bigger killer in Africa than in Western Europe (8.8 deaths versus 1 death per 100,000).


— Central and Southeast Asia have the highest rates of fatal stroke in young adults at about 15 cases per 100,000 deaths. In North America, the rate is about 3 per 100,000.


Globally, heart disease and stroke remain the top killers. Reflecting an older population, lung cancer moved to the 5th cause of death globally, while other cancers including those of the liver, stomach and colon are also in the top 20. AIDS jumped from the 35th cause of death in 1990 to the sixth leading cause two decades later.


While chronic diseases are killing more people nearly everywhere, the overall trend is the opposite in Africa, where illnesses like AIDS, malaria and tuberculosis are still major threats. And experts warn again shifting too much of the focus away from those ailments.


"It's the nature of infectious disease epidemics that if you turn away from them, they will crop right back up," said Jennifer Cohn, a medical coordinator at Doctors Without Borders.


Still, she acknowledged the need to address the surge of other health problems across Africa. Cohn said the agency was considering ways to treat things like heart disease and diabetes. "The way we treat HIV could be a good model for chronic care," she said.


Others said more concrete information is needed before making any big changes to public health policies.


"We have to take this data with some grains of salt," said Sandy Cairncross, an epidemiologist at the London School of Hygiene and Tropical Medicine.


He said the information in some of the Lancet research was too thin and didn't fully consider all the relevant health risk factors.


"We're getting a better picture, but it's still incomplete," he said.


___


Online:


www.lancet.com


http://healthmetricsandevaluation.org


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