Fewer health care options for illegal immigrants

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

___

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

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

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School Shooting Victims Were Shot Multiple Times

The gunman who massacred 20 children in a Connecticut elementary school riddled them with bullets, shooting some of them as many as 11 times, the medical examiner said today.

"I've been at this for a third of a century so my sensibilities may not be the that of the average man, but it's probably the worst I've ever seen," said Chief Medical Examiner H. Wayne Carver II, who has been a medical examiner for 36 years.

A team of 14 medical technicians worked through the night to complete the grisly job of identifying the children killed by Adam Lanza, 20, in the Sandy Hook Elementary School massacre so their names could be released today.

Several weapons were found in the school, including a semi-automatic rifle.

"All the wounds that I know of at this point were caused by the long weapon," Carver said, and many were shot at close range.

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

"I believe many of them were hit more than once," and he said the wounds were "all over" the children's bodies.

"I only did seven of the autopsies. The victims I had ranged from 3 to 11 wounds a piece," Carver said.

The names of the children slain Friday in the Newtown, Conn., school were released today.

To carry out the identifications, Carver said they "did not bring the families and the bodies into contact." He said the identifications were made through photographs of the children's faces. "It's easier on the families," he said.

Additional work is needed to complete the autopsies and identifications of the seven adults slain in Lanza's killing spree.

Emmanuel Dunand/AFP/Getty Images

Newtown Teacher Kept 1st Graders Calm During Massacre Watch Video

Newtown School Shooting: What to Tell Your Kids Watch Video

Fresh details of the massacre emerged including the fact that all of the young victims were first graders in two rooms.

Based on the Sandy Hook school directory, all the kids killed were in the first grade and were in two classrooms.

In one class, 15 of the 16 students listed were killed. In the other class, five of the 16 students died along with their teacher Victoria Soto. Also, nine of the deceased students have siblings in the school.

At a nearby firehouse that has become a center for the town a makeshift memorial and vigil has emerged under a sign that reads "Sandy Hook School." People have left flowers, candles, signs that read "Rest in Peace" and "God Bless Sandy Hook Elementary," as well as a cross made of blue flowers and a wreath of teddy bears

With the tally of Lanza's carnage complete, authorities and the grieving people of Newtown, Conn., are left to wonder why he turned the elementary school in this quaint New England town into a slaughter house.

Connecticut State Police Lt. Paul Vance said the investigation "did produce some very good evidence" about motive, but he would not go into further detail.

He indicated the evidence came from the shooting scene at the school as well as at the home where Lanza's mother, Nancy, was slain.

Also key will be the lone person shot by Lanza who wasn't killed. The female teacher has not been publicly identified.

"She is doing fine," Vance said at a news conference today. "She has been treated and she'll be instrumental in this investigation."

Vance said it appears that reports of an altercation involving Lanza at the school in the days before the mass slaying are not checking out.

Vance said that Lanza forced his way into the school, but did not say how.

Evidence emerged today that Lanza's rampage began in the office of school principal Dawn Hochsprung while the school intercom was on. It's not clear whether it was turned on to alert the school or whether it was on for morning announcements, but the principal's screams and the cries of children heard throughout the school gave teachers time to take precautions to protect their children.

Hochsprung was among those killed in the Friday morning killing spree.

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

Authorities have fanned out to New Jersey, Connecticut and Massachusetts to interview Lanza's relatives, ABC News has learned.

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.

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U.S., rebels urge gloomy Moscow to help oust Assad

BEIRUT (Reuters) - Syria's rebel leadership and the United States seized on Russian pessimism over President Bashar al-Assad's future to urge Moscow to help push its ally into ceding power and end the battles closing in around his capital.

"We want to commend the Russian government for finally waking up to the reality and acknowledging that the regime's days are numbered," the U.S. State Department spokeswoman said after a senior Kremlin envoy conceded publicly on Thursday that Assad's opponents could win the 20-month-old civil war.

"The question now is, will the Russian government join those of us in the international community who are working with the opposition to try to have a smooth democratic transition?" U.S. spokeswoman Victoria Nuland added in Washington.

In Marrakech, where his new coalition won recognition from other international powers as the legitimate leadership of Syria, rebel political leader Mouaz al-Khatib said he believed Russia, ally and arms supplier to the Assad dynasty since Soviet times, was looking for ways out of its support for a lost cause.

"I believe that the Russians have woken up and are sensing that they have implicated themselves with this regime, but they don't know how to get out," al-Khatib told Reuters. He held them "particularly responsible" for helping Assad with arms but said Moscow need not "lose everything" in Syria if it changed tack.

Under President Vladimir Putin, wary since last year's Libyan war of what Russia sees as a Western drive to use the United Nations to overthrow national leaders it dislikes, Russia has blocked U.N. efforts to squeeze Assad, who has also had strong support from his long-time sponsor Iran.

But Mikhail Bogdanov, a deputy foreign minister and the Kremlin's special envoy for Middle East affairs, was quoted as saying in Moscow: "One must look the facts in the face."

"Unfortunately, the victory of the Syrian opposition cannot be ruled out." The Syrian government, he said, was "losing control of more and more territory" and Moscow was preparing to evacuate Russian citizens if necessary.

Nuland said Bogdanov's comments demonstrated that Moscow now "sees the writing on the wall" on Syria and said Russia should now rally behind U.N. efforts to prevent a wider bloodbath.

"They can withdraw any residual support for the Assad regime, whether it is material support (or) financial support," she said. "They can also help us to identify people who might be willing, inside of Syria, to work on a transitional structure."

DIPLOMACY

International envoy Lakhdar Brahimi, who has met Russian and U.S. officials twice in the past week, is seeking a solution based on an agreement reached in Geneva in June that called for the creation of a transitional government in Syria.

But Russia has repeated warnings that recognition of al-Khatib's coalition, notably by the United States, is undermining diplomacy, and rejected U.S. contentions that the Geneva agreement sent a clear message that Assad should step down.

Nuland said the Brahimi meetings could lay the framework for a political structure to follow Assad:

"We've said all along to the Russians that we are concerned that the longer that this goes on, and the longer it takes us to get to an alternative political path for Syria, the only path is going to be the military one and that is just going to bring more violence.

"We all ought to be working together."

Bogdanov, whose government has suggested that Assad himself should be allowed to see through a transition he has promised, suggested the rebels and their allies were set on a military solution and he gave little hint of detente with Washington.

"The fighting will become even more intense and (Syria) will lose tens of thousands and, perhaps, hundreds of thousands of civilians," Bogdanov was quoted as saying. "If such a price for the removal of the president seems acceptable to you, what can we do? We, of course, consider it absolutely unacceptable."

The head of NATO, Anders Fogh Rasmussen, said elsewhere: "I think the regime in Damascus is approaching collapse."

A U.S. official said: "Assad probably still believes that Syria is his and illusions can die hard. But Assad and those closest to him have got to be feeling the psychological strain of fighting a long war that is not going their way."

DAMASCUS BATTLES

But Al-Khatib, who played down Western concerns of sectarian Sunni Islamists in rebel ranks, warned that the fighting was far from over, even as it has begun to rattle the heart of Assad's power in Damascus. On Wednesday, a car bomb killed at least 16 people in a nearby town which is home to many military families.

"The noose is tightening around the regime," al-Khatib said.

"(But) the regime still has power. People think that the regime is finished, but it still has power left, but it is demoralized and however long it lasted its end is clear."

Day and night, Damascenes can hear the thunderous sound of bombardment aimed at rebel-held and contested neighborhoods.

The city's streets have now turned into a labyrinth of checkpoints and road blocks, with several major roads permanently closed off to traffic by concrete barriers.

"We escape from one place and trouble follows," said one grandmother, Um Hassan, as she described to Reuters her family's flight from one neighborhood to another as fighting seeps into the capital. "I don't know where we can keep running to."

Nonetheless, al-Khatib played down demands for their allies to provide heavier weaponry - a request long resisted by governments wary of anti-aircraft missiles and other hardware reaching Islamist rebels who might turn them against the West.

"The Syrian people ... no longer need international forces to protect them," he said, not specifying whether he meant a no-fly zone, arms supplies or other military support.

The opposition chief said he was willing to listen to proposals for Assad to escape with his life - "The best thing is that he steps down and stops drinking the blood of the Syrian people" - and outlined three scenarios for a change of power:

Al-Khatib ruled out the Russian proposal suggesting Assad hand over power to a transitional government while remaining president, saying it was "disgraceful for a slaughtered nation to accept to have a killer and criminal at its head".

The British-based Syrian Observatory said war planes bombed rebel-held eastern suburbs of Damascus on Thursday and artillery was hitting Daraya and Moadamiyeh, southwestern areas near the centre where rebels have been fighting for a foothold.

Syria has relied on war planes and helicopters to bombard rebel districts but Damascus denied accusations by U.S. and NATO officials that it had fired Scud missiles in recent days. The foreign ministry said the long-range missiles were not used against "terrorist groups," a term it uses for the rebels.

At least 40,000 people have been killed in Syria's uprising, which started in March 2011 with street protests which were met with gunfire by Assad's security forces, and which spiraled into the most enduring and destructive of the Arab revolts.

(Additional reporting by Steve Gutterman in Moscow and Andrew Quinn in Washington; Writing by Alastair Macdonald; Editing by Michael Roddy) For an interactive look at the uprising in Syria, please click on http://link.reuters.com/rut37s

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Football: Wenger lucky to avoid sack, says Wright

LONDON: Arsenal legend Ian Wright claims Gunners manager Arsene Wenger is lucky to still have a job because any other boss would have been sacked for going so long without success.

Wright, one of the club's all-time greats, has added his voice to the growing criticism of Wenger in the aftermath of Tuesday's humiliating League Cup quarter-final defeat at Bradford.

Wenger, 63, has not delivered a trophy since the FA Cup in 2005 and the dismal display against League Two minnows Bradford, which ended with a penalty shoot-out loss, has only increased Wright's belief that the Frenchman is losing his fight to stop Arsenal sliding into obscurity.

Wright, who played under Wenger at the end of his seven-year spell with Arsenal, claims his former boss is now living off past glories that will take years to recapture.

"I wouldn't say 'surely he has to go', but it is a unique position he's in because I think any manager in any country in any world with a record like this and no prospect of light at the end of the tunnel, they would've been gone," Wright told Absolute Radio's RocknRoll Football show.

"People are holding onto the fact to what Arsene has done, and people are saying he is going to tarnish what he has done, but I don't think that will ever happen.

"However, it is a long way back. I feel there are a lot of deluded Arsenal fans who are out in the wilderness still saying 'in Arsene we trust' and stuff like that."

Wenger is rightly regarded as Arsenal's greatest ever manager after leading the club to three Premier League titles, four FA Cup and a Champions League final during his 16-year reign, as well introducing an eye-catching style of play that became the envy of the rest of Europe for several years.

But there has been a gradual disintegration of Wenger's squad in recent years, with the likes of Cesc Fabregas, Samir Nasri and Robin van Persie all making moves to more successful clubs.

Wright, who lost his status as Arsenal's record goalscorer to Thierry Henry, believes Wenger needs to be more honest about the state of his squad rather than continually defending the indefensible.

"You hear him doing interviews afterwards saying, 'I have got a great team with a great spirit', but we are not seeing that," Wright added.

"He does not tell the truth for me, he does not say what is happening.

"What is going on? Have you got any money to spend or haven't you? Is it the fact the board are giving you the money and you are not spending? Is that too hard a question to answer for Arsenal?"

-AFP/ac

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Sushil Kumar Shinde, Rehman Malik operationalise new visa regime

NEW DELHI: Travel between India and Pakistan will become easier with the operationalisation of a new visa regime on Friday that allows multi-city visas for up to five cities, visitor visas for two years for senior citizens and children below 12 years, visa on arrival for senior citizens, and group tourist visa, besides exempting specified categories of businessmen from police reporting.

The visa agreement was operationalised by home minister Sushil Kumar Shinde and visiting Pakistani interior minister Rehman Malik, both of whom agreed that it would promote people-to-people contact between the two countries. The visa agreement was signed by the two sides on September 8. Malik said the new visa agreement was not only historic but a step forward for peace.

Outlining the key features of the new visa regime, Shinde said visas can now be granted for five places as against the earlier restriction of three cities. Visitor visas can be issued for up to two years where the applicant is above 65 years of age, where a national of one country is married to a national of the other country and children below 12 years accompanying their parents.

Senior citizens (above 65 years of age) can now avail of visa on arrival, to be issued at Attari/Wagah post for 45 days with a single entry. This will, however, take effect only from January 15, 2013.

In a move aimed at promoting economic ties between the neighbours, business visa norms have been eased, with businessmen with income above 5 million Pakistani rupees or having an annual turnover above 30 million Pakistani rupees now exempt from police reporting.

Indians and Pakistanis can travel to each other's country in groups comprising 10-50 members. The groups, organized by approved tour operators and travel agents, will be issued group tourist visas for 30 days. Group visas will, however, be issued from March 15, 2013.

Entry and exit from different designated check-posts has been allowed, if indicated in the application, though a person can exit from Attari/Wagah on foot only if he had also made the entry on foot from the same check-post.

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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 Killed at Conn. Grade School, 7 Adults

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, a body was also found in the shooter's home, officials said.

Among the dead was Lanza's mother, although it's not clear where she was killed.

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

Sources said the shooter was armed with a Glock semi automatic handgun and a Sig Sauer semi automatic handgun, law enforcement sources told ABC News. Additionally, .223 caliber shell casings--a rifle caliber--were also found at the scene. He was wearing a bullet-proof vest when he opened fire in the elementary school.

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."

Shannon Hicks/The Newtown Bee

Connecticut Elementary School Shooting: 'Several Fatalities' Watch Video

Connecticut Shooting: 27 Dead at Sandy Hook Elementary School Watch Video

Connecticut School Shooting: White House Response Watch Video

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.

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's unclear how many people have been shot, but 27 people, mostly children, are dead, multiple federal and state sources tell ABC News. That number could rise, officials said.

CLICK HERE for more photos from the scene.

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.

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Russia says Syrian rebels might win

MOSCOW/BEIRUT (Reuters) - Syrian rebels are gaining ground and might win, Russia's Middle East envoy said on Thursday, in the starkest such admission from a major ally of President Bashar al-Assad as the 20-month-old civil war closes in on Damascus.

Moscow was "finally waking up to reality", the United States said and it called on Russia to withdraw all support for Assad, who NATO and the rebels' new political leader forecast was heading for collapse.

"One must look the facts in the face," Russia's state-run RIA quoted Mikhail Bogdanov as saying. "Unfortunately, the victory of the Syrian opposition cannot be ruled out."

Bogdanov, a deputy foreign minister and the Kremlin's special envoy for Middle East affairs, said the Syrian government was "losing control of more and more territory" and Moscow was preparing to evacuate Russian citizens if necessary.

In Washington, State Department spokeswoman Victoria Nuland said: "We want to commend the Russian government for finally waking up to the reality and acknowledging that the regime's days are numbered.

"The question now is, will the Russian government join those of us in the international community who are working with the opposition to try to have a smooth democratic transition?"

Syria has relied on war planes and helicopters to bombard rebel districts but Damascus denied accusations by U.S. and NATO officials that it had fired Scud missiles in recent days.

The foreign ministry said the long-range missiles were not used against "terrorist groups," a term it uses for the rebels, who now hold an almost continuous arc of territory from the east to the southwest of Damascus.

The head of NATO said he thought Assad's government was nearing collapse and the new leader of Syria's opposition told Reuters the people of Syria no longer needed international forces to protect them.

"The horrific conditions which the Syrian people endured prompted them to call on the international community for military intervention at various times," said Mouaz al-Khatib, a preacher who heads Syria's National Coalition.

"Now the Syrian people have nothing to lose. They handled their problems by themselves. They no longer need international forces to protect them," he added in the interview on Wednesday night, accusing the international community of slumbering while Syrians were killed.

He did not specify whether by intervention he meant a no-fly zone that rebels have been demanding for month, a ground invasion - which the opposition has warned against - or arms.

He said the opposition would consider any proposal from Assad to surrender power and leave the country, but would not give any assurances until it saw a firm proposal.

In the latest blow to the government, a car bomb killed at least 16 men, women and children in Qatana, a town about 25 km (15 miles) southwest of Damascus where many soldiers live, activists and state media said.

The explosion occurred in a residential area for soldiers in Qatana, which is near several army bases, said Rami Abdelrahman, head of the pro-opposition Syrian Observatory for Human Rights.

He put the death toll as 17, including seven children and two women. State news agency SANA said 16 people had died.

State television showed soldiers walking by a partly collapsed building, with rubble and twisted metal on the road.

The pro-government Al-Ikhbariya TV said a second car bomb in the Damascus suburb of al-Jadideh killed eight, most of them women and children.

Apart from gaining territory in the outskirts of Damascus in recent weeks, rebels have also made hit-and-run attacks or set off bombs within the capital, often targeting state security buildings or areas seen as loyal to Assad, such as Jaramana, where twin bombs killed 34 people in November.

The Pakistani Foreign Office said security concerns had prompted it to withdraw the ambassador and all Pakistani staff from the embassy in the central suburb of East Mezzeh, a couple miles from the Interior Ministry.

BACK TO THE WALL

With his back to the wall, Assad was reported to be turning ever deadlier weapons on his adversaries.

"I think the regime in Damascus is approaching collapse," NATO Secretary-General Anders Fogh Rasmussen said on Thursday.

Human Rights Watch said some populated areas had been hit by incendiary bombs, containing flammable materials such as napalm, thermite or white phosphorous, which can set fire to buildings or cause severe burns and respiratory damage.

The British-based Syrian Observatory said war planes were bombing rebel-held eastern suburbs of Damascus on Thursday and artillery was hitting Daraya and Moadamiyeh, southwestern areas near the centre where rebels have been fighting for a foothold.

At least 40,000 people have been killed in Syria's uprising, which started in March 2011 with street protests which were met with gunfire by Assad's security forces, and which spiraled into the most enduring and destructive of the Arab revolts.

The United States, European powers and Arab states bestowed their official blessing on Syria's newly-formed opposition coalition on Wednesday, despite increasing signs of Western unease at the rise of militant Islamists in the rebel ranks.

Western nations at "Friends of Syria" talks in Marrakech, Morocco rallied around a new opposition National Coalition formed last month under moderate Islamist cleric al-Khatib.

Russia, which along with China has blocked any U.N. Security Council measures against Assad, criticized Washington's decision to grant the coalition formal recognition, saying it appeared to have abandoned any effort to reach a political solution.

Bogdanov's remarks were the clearest sign yet that Russia is preparing for the possible defeat of Assad's government.

"We are dealing with issues of preparations for an evacuation. We have mobilization plans and are clarifying where our citizens are located," Bogdanov said.

The fall of Damascus to the rebels was not a prospect Moscow relished: "The fighting will become even more intense and (Syria) will lose tens of thousands and, perhaps, hundreds of thousands of civilians," Bogdanov told Russia Today television.

"If such a price for the removal of the president seems acceptable to you, what can we do? We, of course, consider it absolutely unacceptable."

Nuland said Russia should now back away from Assad: "They can withdraw any residual support for the Assad regime, whether it is material support (or) financial support," she said.

"They can also help us to identify people who might be willing inside of Syria to work on a transitional structure."

A British Foreign Office spokesperson said the Russian position remained largely unchanged but the situation on the ground gave Moscow an interest in finding an agreed solution, even if the chances of such a solution remained slim.

"If Russia's position on Syria had been a brick wall, it is now a brick wall with a crack in it," the spokesperson said.

(Additional reporting by Dominic Evans in Beirut, Samia Nakhoul and Khaled Yacoub Oweis in Marrakech, Andrew Quinn in Washington and Mohammed Abbas in London; Editing by Philippa Fletcher and Alastair Macdonald)

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Swimming: Le Clos strikes double blow, Seto in rookie win

ISTANBUL: South Africa's Olympic 100m butterfly champion Chad Le Clos added the world short course crown to his collection on Thursday with a commanding victory in the final.

Le Clos won in 48.82sec, ahead of American duo Thomas Shields, in 49.54sec, with Ryan Lochte, who captured gold in the 200m freestyle and 4x100m freestyle relay on Wednesday, taking bronze in 49.59sec.

"I was a little nervous before the final. Lochte was a bit of an unknown. But I had him and Shields in the lanes next to mine, so it was a good set-up on both sides," said the 20-year-old Le Clos, whose time was a championship record.

Japanese teenager Daiya Seto won his first international title with victory in the 400m medley.

The 18-year-old's 3min 59.15sec pushed the great Hungarian Laszlo Cseh, who clocked 4:00.50, into second place.

Cseh, a seven-time European champion, has still to claim a world title.

"I did not feel good in the butterfly leg, but I tried to fight. In the backstroke leg I could relax and finish well," said Seto.

"Even though this is short course, these are still world championships and I am very excited. This victory is going to give me confidence for the long course competitions."

Seto wasn't the youngest winner on the night.

That honour went to 15-year-old Lithuanian Ruta Meilutyte who won the women's 50m breaststroke, having taken a long spell out of the sport following her 100m gold at the Olympics.

The teenager won in a time of 29.44sec ahead of Jamaica's Alia Atkinson, in 29.67, and Sarah Katsoulis of Australia in 29.94sec.

"I really didn't expect it," said Meilutyte. "At the moment it feels just like I have swum a normal race, but it will start sinking in. It's crazy."

America's Olympic 100m backstroke champion Matt Grevers won his first individual world title over the same distance, dethroning favourite Stanislav Donets of Russia.

Grevers touched in 49.89sec with Donets in 49.91sec.

"Stanislav is without doubt the king of the short course and I am the king of the long course," said Grevers.

"I considered myself pretty good, but he was as well. I am glad I beat him on this one."

- AFP/ac

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Govt seeks Trai's opinion on cable monopolies

NEW DELHI: The government has sought broadcast regulator Trai's views to prevent monopolistic operations by cable operators and multi-system operators, expressing concern that it might have serious implications in terms of competition, pricing and healthy growth of the cable TV sector in the market.

In a statement, the information and broadcasting (I&B) ministry said, "It has been observed that cable TV distribution is virtually monopolized in some states as operation of the entire cable TV network is dominated by a single entity. At present, there are no restrictions on the issue of accumulation of interest in terms of market share in a city, district, state or country by individual MSOs and LCOs in the cable sector."

MSOs and cable operators are free to operate in any area of their choice after obtaining registration from the ministry. "It is felt that such monopolies may not be in the interest of consumers and may have serious implications in terms of competition, pricing and healthy growth of cable TV sector in that market," the ministry said.

The ministry has requested Trai to provide its recommendations on whether "in order to ensure fair competition, improved quality of service, and equity, should any restriction be imposed on MSOs/LCOs to prevent monopolies/accumulation of interest? If yes, what restrictions should be imposed and what should be the form, nature and scope of such restrictions?" The regulator will also explore the necessity of amending the Cable Television Networks (Regulation) Act, 1995.

MSOs and cable operators are required to be registered with local post offices to be able to operate in the permitted areas of registration. However, as per recent amendments in the Cable Television Networks (Regulation) Amendment Rules 2012, it has become mandatory for MSOs to register with the I&B ministry to operate.

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