Kenya hospital imprisons new mothers with no money

NAIROBI, Kenya (AP) — The director of the Pumwani Maternity Hospital, located in a hardscrabble neighborhood of downtown Nairobi, freely acknowledges what he's accused of: detaining mothers who can't pay their bills. Lazarus Omondi says it's the only way he can keep his medical center running.

Two mothers who live in a mud-wall and tin-roof slum a short walk from the maternity hospital, which is affiliated with the Nairobi City Council, told The Associated Press that Pumwani wouldn't let them leave after delivering their babies. The bills the mothers couldn't afford were $60 and $160. Guards would beat mothers with sticks who tried to leave without paying, one of the women said.

Now, a New York-based group has filed a lawsuit on the women's behalf in hopes of forcing Pumwani to stop the practice, a practice Omondi is candid about.

"We hold you and squeeze you until we get what we can get. We must be self-sufficient," Omondi said in an interview in his hospital office. "The hospital must get money to pay electricity, to pay water. We must pay our doctors and our workers."

"They stay there until they pay. They must pay," he said of the 350 mothers who give birth each week on average. "If you don't pay the hospital will collapse."

The Center for Reproductive Rights, which filed the suit this month in the High Court of Kenya, says detaining women for not paying is illegal. Pumwani is associated with the Nairobi City Council, one reason it might be able to get away with such practices, and the patients are among Nairobi's poorest with hardly anyone to stand up for them.

Maimouna Awuor was an impoverished mother of four when she was to give birth to her fifth in October 2010. Like many who live in Nairobi's slums, Awuor performs odd jobs in the hopes of earning enough money to feed her kids that day. Awuor, who is named in the lawsuit, says she had saved $12 and hoped to go to a lower-cost clinic but was turned away and sent to Pumwani. After giving birth, she couldn't pay the $60 bill, and was held with what she believes was about 60 other women and their infants.

"We were sleeping three to a bed, sometimes four," she said. "They abuse you, they call you names," she said of the hospital staff.

She said saw some women tried to flee but they were beaten by the guards and turned back. While her husband worked at a faraway refugee camp, Awuor's 9-year-old daughter took care of her siblings. A friend helped feed them, she said, while the children stayed in the family's 50-square-foot shack, where rent is $18 a month. She says she was released after 20 days after Nairobi's mayor paid her bill. Politicians in Kenya in general are expected to give out money and get a budget to do so.

A second mother named in the lawsuit, Margaret Anyoso, says she was locked up in Pumwani for six days in 2010 because she could not pay her $160 bill. Her pregnancy was complicated by a punctured bladder and heavy bleeding.

"I did not see my child until the sixth day after the surgery. The hospital staff were keeping her away from me and it was only when I caused a scene that they brought her to me," said Anyoso, a vegetable seller and a single mother with five children who makes $5 on a good day.

Anyoso said she didn't have clothes for her child so she wrapped her in a blood-stained blouse. She was released after relatives paid the bill.

One woman says she was detained for nine months and was released only after going on a hunger strike. The Center for Reproductive Rights says other hospitals also detain non-paying patients.

Judy Okal, the acting Africa director for the Center for Reproductive Rights, said her group filed the lawsuit so all Kenyan women, regardless of socio-economic status, are able to receive health care without fear of imprisonment. The hospital, the attorney general, the City Council of Nairobi and two government ministries are named in the suit.

___

Associated Press reporter Tom Odula contributed to this report.

Read More..

Numerous women sexually assaulted by taxi driver, police say

Manhattan Beach Police released the photo of a taxi driver suspected of sexually assaulting multiple women in the South Bay region.

Torrance resident Sameh Shenouda, 38, was arrested in November on charges of sexually assaulting a woman in August, according to Manhattan Beach Det. Michael Rosenberger.

“The victim did not initially report the crime until she saw a news report of a similar offense occurring in Redondo Beach,” Rosenberger said.

News of Shenouda’s arrest prompted other women to come forward with information.

Rosenberger said Shenouda would offer rides to women who were walking in the evening. He would open the front passenger door so they would sit up front with him, making it easier to assault them, he said.

The United Taxi, Shenouda’s employer, has been “very cooperative with investigators,” Rosenberger said.

Manhattan Beach police are asking that if anyone has been assaulted or touched inappropriately by a taxi driver in the South Bay in the last year to contact detectives at (310) 802-5127.

ALSO:

Submit your photos

Quiz: Test your photography knowledge

Southern California Moments: Best of November

-- Dalina Castellanos

Photo: Sameh Shenouda. Credit: Manhattan Beach Police Department.

Read More..

Syrian General in Charge of Stopping Defections Becomes a Defector

Aref Heretani/Reuters.

Mannequins were set up to confuse snipers loyal to President Bashar al-Assad in the old city of Aleppo on Sunday.

BEIRUT, Lebanon — Syria’s government suffered an embarrassing new setback as the top general responsible for preventing defections within the military became a defector himself, making what insurgents described on Wednesday as a daring back-roads escape by motorcycle across the border into Turkey.

The defector, Maj. Gen. Abdul Aziz Jassem al-Shallal, the chief of the military police, was one of the highest-ranking military officers to abandon President Bashar al-Assad in the nearly two-year-old uprising against him.

His departure, first reported by Al Arabiya late on Tuesday evening and confirmed by opposition figures on Wednesday, came as a flurry of diplomatic activity suggested the possibility of movement toward a political solution to the Syrian crisis. A deputy Syrian foreign minister flew to Moscow for meetings with Kremlin officials, and the international envoy who met with Mr. Assad in Damascus earlier this week was planning to visit Moscow this weekend. Russia, one of Mr. Assad’s most ardent foreign defenders, has in recent weeks suggested it was open to a negotiated transition that would ease him out of power.

Opposition figures said General Shallal’s defection had taken weeks to prepare and ended with a four-hour sprint by motorcycle to the Turkish border, driving through woods and on muddy roads. In a video broadcast by Al Arabiya, the general said that he had taken the step because the Syrian military had deviated from its mission to protect the country, and had transformed into “a gang for killing and destruction.”

“The regime army has lost control over most of the country,” the general said in an interview on the Saudi-owned channel, which has heavily criticized the Syrian government.

Opposition fighters embraced the defection as more than a symbolic blow to the government because of the general’s primary responsibility as an enforcer of Mr. Assad’s repression of dissent and guarantor of loyalty by the armed forces. As head of the military police, General Shallal was responsible for the department that was supposed to stop defections. He also presided over a force that guarded prisons where civilian dissidents were held.

Maj. Ibrahim Moutawe, who defected from the Syrian Army a year ago, said defection was a “last resort” for high-ranking officials like General Shallal. “They only consider it when fear and danger begin to threaten them directly, and when the regime can no longer protect them,” he said.

General Shallal was not a member of Mr. Assad’s inner circle, and analysts said that the defections of other officials with impressive titles — including the prime minister, a brigadier general and a well-known government spokesman — had done little to shake Mr. Assad’s basic hold on power.

More critically, the opposition has failed to attract either officers or rank-and-file soldiers belonging to Syria’s Alawite minority, the sect that Mr. Assad belongs to, doing little to assuage fears among Alawites that the Sunni-led insurgency threatens their existence, analysts said.

But the departure of a major general who publicly condemned the armed forces seemed likely to undercut Mr. Assad’s attempts to maintain morale.

The negotiations for the general’s defection began weeks ago, after members of his tribe reached out to opposition commanders, according to Louay Mekdad, the political and media coordinator for the Free Syrian Army, an umbrella organization for rebel fighting groups. Mr. Mekdad said that the general had tried to defect several times before, but had been prevented for what he called “technical reasons,” without giving any more detail.

Rebel commanders gave differing accounts of how much power the general had held in Syria. One commander said he had been a member of Mr. Assad’s “crisis team” of top military, security and intelligence officials coordinating the government’s response to the war. Capt. Adnan Dayoub, a rebel commander in Hama, said that General Shallal had been responsible for prisons — “God knows how many,” he said — and was almost certainly guilty of crimes.

“He’s contaminated from top to bottom,” the captain said. “Tomorrow he will be a hero.”

Kareem Fahim reported from Beirut, and Rick Gladstone from New York. Reporting was contributed by Hwaida Saad from Beirut, Ellen Barry from Moscow, Hala Droubi from Dubai, United Arab Emirates, and Eric Schmitt from Washington.

Read More..

Channing Tatum Cradles Wife Jenna Dewan-Tatum's Baby Bump

By Marla Lehner

12/26/2012 at 06:40 PM EST

Channing Tatum is already being sweet with his baby.

PEOPLE's Sexiest Man Alive, who announced earlier this month that he and his wife are expecting their first child, posted an adorable picture of himself cradling Jenna Dewan-Tatum's growing baby bump on Christmas Day.

"Merry Christmas," the Magic Mike hunk wrote on his WhoSay page where he shared the photo of the couple, both 32, smiling and dressed in matching baseball caps.

On Christmas Eve, Dewan-Tatum Tweeted a holiday message to her followers, saying, "Merry Christmas and happy holidays to you all!! Hope you are having fun with loved ones! Xox."

Discussing starting a family, "I'm ready; I think she’s ready," Tatum told PEOPLE recently. "The first number that pops into my head is three, but I just want one to be healthy and then we'll see where we go after that."

Read More..

Predicting who's at risk for violence isn't easy

CHICAGO (AP) — It happened after Columbine, Virginia Tech, Aurora, Colo., and now Sandy Hook: People figure there surely were signs of impending violence. But experts say predicting who will be the next mass shooter is virtually impossible — partly because as commonplace as these calamities seem, they are relatively rare crimes.

Still, a combination of risk factors in troubled kids or adults including drug use and easy access to guns can increase the likelihood of violence, experts say.

But warning signs "only become crystal clear in the aftermath, said James Alan Fox, a Northeastern University criminology professor who has studied and written about mass killings.

"They're yellow flags. They only become red flags once the blood is spilled," he said.

Whether 20-year-old Adam Lanza, who used his mother's guns to kill her and then 20 children and six adults at their Connecticut school, made any hints about his plans isn't publicly known.

Fox said that sometimes, in the days, weeks or months preceding their crimes, mass murderers voice threats, or hints, either verbally or in writing, things like "'don't come to school tomorrow,'" or "'they're going to be sorry for mistreating me.'" Some prepare by target practicing, and plan their clothing "as well as their arsenal." (Police said Lanza went to shooting ranges with his mother in the past but not in the last six months.)

Although words might indicate a grudge, they don't necessarily mean violence will follow. And, of course, most who threaten never act, Fox said.

Even so, experts say threats of violence from troubled teens and young adults should be taken seriously and parents should attempt to get them a mental health evaluation and treatment if needed.

"In general, the police are unlikely to be able to do anything unless and until a crime has been committed," said Dr. Paul Appelbaum, a Columbia University professor of psychiatry, medicine and law. "Calling the police to confront a troubled teen has often led to tragedy."

The American Academy of Child & Adolescent Psychiatry says violent behavior should not be dismissed as "just a phase they're going through."

In a guidelines for families, the academy lists several risk factors for violence, including:

—Previous violent or aggressive behavior

—Being a victim of physical or sexual abuse

—Guns in the home

—Use of drugs or alcohol

—Brain damage from a head injury

Those with several of these risk factors should be evaluated by a mental health expert if they also show certain behaviors, including intense anger, frequent temper outbursts, extreme irritability or impulsiveness, the academy says. They may be more likely than others to become violent, although that doesn't mean they're at risk for the kind of violence that happened in Newtown, Conn.

Lanza, the Connecticut shooter, was socially withdrawn and awkward, and has been said to have had Asperger's disorder, a mild form of autism that has no clear connection with violence.

Autism experts and advocacy groups have complained that Asperger's is being unfairly blamed for the shootings, and say people with the disorder are much more likely to be victims of bullying and violence by others.

According to a research review published this year in Annals of General Psychiatry, most people with Asperger's who commit violent crimes have serious, often undiagnosed mental problems. That includes bipolar disorder, depression and personality disorders. It's not publicly known if Lanza had any of these, which in severe cases can include delusions and other psychotic symptoms.

Young adulthood is when psychotic illnesses typically emerge, and Appelbaum said there are several signs that a troubled teen or young adult might be heading in that direction: isolating themselves from friends and peers, spending long periods alone in their rooms, plummeting grades if they're still in school and expressing disturbing thoughts or fears that others are trying to hurt them.

Appelbaum said the most agonizing calls he gets are from parents whose children are descending into severe mental illness but who deny they are sick and refuse to go for treatment.

And in the case of adults, forcing them into treatment is difficult and dependent on laws that vary by state.

All states have laws that allow some form of court-ordered treatment, typically in a hospital for people considered a danger to themselves or others. Connecticut is among a handful with no option for court-ordered treatment in a less restrictive community setting, said Kristina Ragosta, an attorney with the Treatment Advocacy Center, a national group that advocates better access to mental health treatment.

Lanza's medical records haven't been publicly disclosed and authorities haven't said if it is known what type of treatment his family may have sought for him. Lanza killed himself at the school.

Jennifer Hoff of Mission Viejo, Calif. has a 19-year-old bipolar son who has had hallucinations, delusions and violent behavior for years. When he was younger and threatened to harm himself, she'd call 911 and leave the door unlocked for paramedics, who'd take him to a hospital for inpatient mental care.

Now that he's an adult, she said he has refused medication, left home, and authorities have indicated he can't be forced into treatment unless he harms himself — or commits a violent crime and is imprisoned. Hoff thinks prison is where he's headed — he's in jail, charged in an unarmed bank robbery.

___

Online:

American Academy of Child & Adolescent Psychiatry: http://www.aacap.org

___

AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner

Read More..

Girlfriend denies helping actor kill college students

A woman accused of helping her former fiance cover up two gruesome murders pleaded not guilty Wednesday to three felonies she faces in connection with the crime.

Prosecutors say aspiring actress Rachel Buffett, 25, lied to police and repeated a fabricated account that Daniel Wozniak, 28, initially told detectives.

Wozniak is charged in the 2010 murders of Orange Coast College students Samuel Herr, 26, and Julie Kibuishi, 23.

At the time of the killings, Wozniak and Buffett were starring in a community theater production of the musical "Nine."

Prosecutors allege that on May 21, 2010, Wozniak lured Herr, his neighbor, to a theater facility at the Los Alamitos Joint Forces Training Base, then shot him twice in the head before stealing his ATM, wallet and cellphone.

Later that evening, Wozniak allegedly used Herr's cellphone to send a text message to Kibuishi, a friend of Herr's, to lure her to his apartment.

Authorities believe Wozniak shot Kibuishi twice in the head, and then removed some of her clothing to make it look like she was sexually assaulted.

Prosecutors say Wozniak later returned to the theater, where he allegedly cut off Herr's head, left arm and right hand before dispersing the body parts at a theater and in a local park.

Wozniak was arrested on May 26, 2010, at his bachelor party in Huntington Beach, after police traced money taken from Herr's account to him.

Prosecutors say that Wozniak wanted to steal Herr's savings account to pay for his wedding to Buffett and their honeymoon.

Wozniak has pleaded not guilty to two felony counts of special-circumstances murder and is still awaiting trial. He faces the death penalty if convicted.

Buffett was arrested Nov. 20 on suspicion of being an accessory to murder after the fact.

She faces three felony counts of accessory after the fact and is currently free on $1 million bail. Buffett could get a maximum of four years in state prison if convicted.

ALSO:

Horse rescued from hayloft after wandering upstairs

Planned avalanche turns deadly, killing ski patrol veteran

Volunteers can still help with Glendale Rose Parade float

-- Times Community News

Video: At a news conference in Long Beach earlier this month, Rachel Buffett discusses the charges she's facing. Credit: Ruben Vives / Los Angeles Times

Read More..

South Korea Seeks to Buy Spy Drones

WASHINGTON (Reuters) — The Obama administration formally proposed a sale of advanced spy drones to help South Korea take a more active role in its own defense from any attack by the heavily armed North.

Seoul has requested a possible $1.2 billion sale of four Northrop Grumman Global Hawks, remotely piloted aircraft with enhanced surveillance capabilities, according to a statement by the Pentagon’s Defense Security Cooperation Agency dated Monday and distributed Tuesday.

South Korea needs such systems to assume top responsibility for intelligence-gathering from the United States-led Combined Forces Command as scheduled in 2015, the security agency said in releasing a notice to American lawmakers. The aircraft “will maintain adequate intelligence, surveillance, and reconnaissance capabilities and will ensure the alliance is able to monitor and deter regional threats in 2015 and beyond,” the notice said.

The military partnership grew from the American role in the 1950-53 Korean War, and is being phased out. Seoul has shown interest in the high-altitude, long-endurance Global Hawk platform for at least four years.

The possible sale has been held up by discussions involving price, aircraft configuration and a deliberately slow pace in releasing of such technology, which is subject to a voluntary 34-nation arms control pact.

Read More..

Boston Cop Rescues Drowning Woman

A Boston police officer is being hailed a hero after he jumped into the frigid cold water to rescue a drowning woman.

Cell phone video showed police officer Edward Norton plunging into Fort Point channel Friday afternoon during a torrential downpour to rescue the unidentified woman who’d reportedly fallen in by accident.

Norton, who just happened to be in the right place at the right time, says he didn’t think twice about jumping in.

“It just kind of happened. I saw here there. Someone had to do it,” Norton told ABC News. “As I was in the air, I was thinking I don’t know what’s under the water.”

Once in the water, Norton’s bullet-proof vest weighed him down, making the rescue more complicated than he anticipated. Onlookers did their part by tossing in a life preserver, which helped keep the frantic woman afloat.

“She kept saying stuff like, ‘I can’t hold on.’ So, I told her, ‘Hold on. Help is coming,’” Norton said. The officer remained with the woman in the water until firefighters arrived on the scene and pulled them both out of the water to safety.

Both were taken to local hospitals and checked for hypothermia, but were released with a clean bill of health.

As for the people calling Norton a hero, he says, not really because it’s all in a day’s work.

“I feel like I did what I would expect to do for one of my loved ones. My wife, my daughter, anyone,” Norton said.

While everyone made it out of the water safely with no injuries, there was one casualty so to speak. Norton says his wedding band slipped off when he hit the water and hero or not, his wife is none too pleased.

Also Read
Wireless News Headlines – Yahoo! News

Title Post: Boston Cop Rescues Drowning Woman
Rating:
100%

based on 99998 ratings.
5 user reviews.
Author: Fluser SeoLink
Thanks for visiting the blog, If any criticism and suggestions please leave a comment

Read More..

Predicting who's at risk for violence isn't easy

CHICAGO (AP) — It happened after Columbine, Virginia Tech, Aurora, Colo., and now Sandy Hook: People figure there surely were signs of impending violence. But experts say predicting who will be the next mass shooter is virtually impossible — partly because as commonplace as these calamities seem, they are relatively rare crimes.

Still, a combination of risk factors in troubled kids or adults including drug use and easy access to guns can increase the likelihood of violence, experts say.

But warning signs "only become crystal clear in the aftermath, said James Alan Fox, a Northeastern University criminology professor who has studied and written about mass killings.

"They're yellow flags. They only become red flags once the blood is spilled," he said.

Whether 20-year-old Adam Lanza, who used his mother's guns to kill her and then 20 children and six adults at their Connecticut school, made any hints about his plans isn't publicly known.

Fox said that sometimes, in the days, weeks or months preceding their crimes, mass murderers voice threats, or hints, either verbally or in writing, things like "'don't come to school tomorrow,'" or "'they're going to be sorry for mistreating me.'" Some prepare by target practicing, and plan their clothing "as well as their arsenal." (Police said Lanza went to shooting ranges with his mother in the past but not in the last six months.)

Although words might indicate a grudge, they don't necessarily mean violence will follow. And, of course, most who threaten never act, Fox said.

Even so, experts say threats of violence from troubled teens and young adults should be taken seriously and parents should attempt to get them a mental health evaluation and treatment if needed.

"In general, the police are unlikely to be able to do anything unless and until a crime has been committed," said Dr. Paul Appelbaum, a Columbia University professor of psychiatry, medicine and law. "Calling the police to confront a troubled teen has often led to tragedy."

The American Academy of Child & Adolescent Psychiatry says violent behavior should not be dismissed as "just a phase they're going through."

In a guidelines for families, the academy lists several risk factors for violence, including:

—Previous violent or aggressive behavior

—Being a victim of physical or sexual abuse

—Guns in the home

—Use of drugs or alcohol

—Brain damage from a head injury

Those with several of these risk factors should be evaluated by a mental health expert if they also show certain behaviors, including intense anger, frequent temper outbursts, extreme irritability or impulsiveness, the academy says. They may be more likely than others to become violent, although that doesn't mean they're at risk for the kind of violence that happened in Newtown, Conn.

Lanza, the Connecticut shooter, was socially withdrawn and awkward, and has been said to have had Asperger's disorder, a mild form of autism that has no clear connection with violence.

Autism experts and advocacy groups have complained that Asperger's is being unfairly blamed for the shootings, and say people with the disorder are much more likely to be victims of bullying and violence by others.

According to a research review published this year in Annals of General Psychiatry, most people with Asperger's who commit violent crimes have serious, often undiagnosed mental problems. That includes bipolar disorder, depression and personality disorders. It's not publicly known if Lanza had any of these, which in severe cases can include delusions and other psychotic symptoms.

Young adulthood is when psychotic illnesses typically emerge, and Appelbaum said there are several signs that a troubled teen or young adult might be heading in that direction: isolating themselves from friends and peers, spending long periods alone in their rooms, plummeting grades if they're still in school and expressing disturbing thoughts or fears that others are trying to hurt them.

Appelbaum said the most agonizing calls he gets are from parents whose children are descending into severe mental illness but who deny they are sick and refuse to go for treatment.

And in the case of adults, forcing them into treatment is difficult and dependent on laws that vary by state.

All states have laws that allow some form of court-ordered treatment, typically in a hospital for people considered a danger to themselves or others. Connecticut is among a handful with no option for court-ordered treatment in a less restrictive community setting, said Kristina Ragosta, an attorney with the Treatment Advocacy Center, a national group that advocates better access to mental health treatment.

Lanza's medical records haven't been publicly disclosed and authorities haven't said if it is known what type of treatment his family may have sought for him. Lanza killed himself at the school.

Jennifer Hoff of Mission Viejo, Calif. has a 19-year-old bipolar son who has had hallucinations, delusions and violent behavior for years. When he was younger and threatened to harm himself, she'd call 911 and leave the door unlocked for paramedics, who'd take him to a hospital for inpatient mental care.

Now that he's an adult, she said he has refused medication, left home, and authorities have indicated he can't be forced into treatment unless he harms himself — or commits a violent crime and is imprisoned. Hoff thinks prison is where he's headed — he's in jail, charged in an unarmed bank robbery.

___

Online:

American Academy of Child & Adolescent Psychiatry: http://www.aacap.org

___

AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner

Read More..

Affordable Care Act presents many unknowns for California officials

SACRAMENTO — As California positions itself at the vanguard of the national healthcare overhaul, state officials are unable to say for sure how much their implementation of the federal Affordable Care Act will cost taxpayers.

The program, intended to insure millions of Americans who are now without health coverage, takes states into uncharted territory. California, which plans to expand coverage to hundreds of thousands of people when the law takes effect in 2014, faces myriad unknowns. The Brown administration will try to estimate the cost of vastly more health coverage in the budget plan it unveils next month, but experts warn that its numbers could be way off.

Officials don't know exactly how many Californians will sign up for Medi-Cal, the public health insurance program for the poor. Computing the cost of care for each of them is also guesswork. And California is waiting for key rulings from federal regulators that could have a major effect on the final price tag, perhaps in the hundreds of millions of dollars.

"No one has ever tried to do anything like this before," said Michael Cannon, director of health policy studies at the conservative Cato Institute. "Any numbers attached to this are just a guess."

The uncertainty comes as the state's finances are improving but still precarious. Voters approved billions of dollars in new taxes last month, but Sacramento nevertheless faces a shortfall of $1.9 billion that must be bridged in fiscal 2013-14.

Unanticipated costs associated with the healthcare changes could undermine California's efforts to improve its standing on Wall Street and keep the economy moving. They could force fresh cuts in services if they consume much more of the state budget than Brown is able to approximate.

In addition, some Democrats in the Legislature hope to restore certain health benefits, such as dental coverage for Medi-Cal recipients, that have been eliminated or reduced amid the persistent financial crises of recent years. The cost of any services that are revived could rise as more people become eligible for them.

Gov. Jerry Brown expressed a new concern in an interview last week. He said recent signs from Washington suggest the federal government may not pay as much of the costs associated with the new law as originally promised, sticking states with a larger share of the bill.

"As the guardian of the public purse here, I have to watch very closely what may come out of Washington," the governor said. "So we're going to move carefully. We want to make sure the federal government is on board."

Cost estimates for California have differed widely.

In 2010, the year the Affordable Care Act was signed, state officials said California could be on the hook for $2.7 billion annually. The nonpartisan legislative analyst estimated this fall that initial costs would be in the "low hundreds of millions of dollars" annually for the next several years. A recent study from the nonprofit Kaiser Family Foundation pegged the price at nearly $14 billion over the next decade.

The main cost is expected to come from a sharp increase in the number of Medi-Cal enrollees. Sacramento and Washington split the bill for those Californians, who currently number roughly 8 million. The state's share was about $14.6 billion this year.

Sacramento will be responsible for half the cost of many new Medi-Cal recipients. That number could be anywhere from 200,000 to 440,000 people in 2014, according to Ken Jacobs, chairman of the Labor Center at UC Berkeley.

Jacobs says early estimates are that these new enrollees will be cheaper to treat than current Medi-Cal recipients because they are expected to be younger and healthier. But experts caution that nobody knows for sure.

"There is a high margin of error when trying to make these estimates," said Janet Coffman, a professor at the UC San Francisco Institute for Health Policy Studies. "And with the budget, there's always an element of politics in terms of which sets of numbers you decide to use."

With so many more Californians about to be insured, administration officials have suggested they would propose reducing the annual $1.4 billion Sacramento pays to counties to help them care for the uninsured. The administration is also contemplating cuts in state-funded programs aimed at the uninsured, such as breast-cancer screening and family-planning services. They say demand for such aid will fall as more people obtain coverage.

The counties, which by law are ultimately responsible for paying to treat the uninsured, would be likely to fight such moves.

"Counties will say there is still a need to keep the safety net intact and that [the state] can't take the money before people are actually enrolled," said Chris Perrone, deputy director of health reform and public programs at the California Healthcare Foundation, an Oakland-based nonprofit.

Even after the federal law is enacted, millions of Californians are expected to be without coverage. There are currently about 8.2 million uninsured, according to the UCLA Center for Health Policy Research. Models from UC Berkeley assume the number will be about half that by 2019.

Those who remain uninsured would still show up at hospital emergency rooms, and counties would still be responsible for their care.

Already, local officials are bracing for the worst. In a letter to Brown this month, the L.A. County Board of Supervisors expressed concern about any impending cuts.

Reducing payments to counties "prior to a full assessment and understanding" of the effects of the healthcare changes, the supervisors wrote, "is not reasonable."

anthony.york@latimes.com

Read More..