Study: Drug coverage to vary under health law

WASHINGTON (AP) — A new study says basic prescription drug coverage could vary dramatically from state to state under President Barack Obama's health care overhaul.

That's because states get to set benefits for private health plans that will be offered starting in 2014 through new insurance exchanges.

The study out Tuesday from the market analysis firm Avalere Health found that some states will require coverage of virtually all FDA-approved drugs, while others will only require coverage of about half of medications.

Consumers will still have access to essential medications, but some may not have as much choice.

Connecticut, Virginia and Arizona will be among the states with the most generous coverage, while California, Minnesota and North Carolina will be among states with the most limited.

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100,000 protest at presidential palace

CAIRO (AP) — More than 100,000 Egyptians protested outside the presidential palace in Cairo on Tuesday, fueling tensions over Islamist leader Mohammed Morsi's seizure of nearly unrestricted powers and the adoption by his allies of a controversial draft constitution.

The outpouring of anger across the Egyptian capital, the Mediterranean port of Alexandria and a string of other cities pointed to a prolonged standoff between the president and a newly united opposition.

Morsi's opponents, long fractured by bickering and competing egos, have been re-energized since he announced decrees last month that place him above oversight of any kind, including by the courts, and provide immunity to two key bodies dominated by his allies: The 100-member panel drafting the constitution and parliament's upper chamber.

The decrees have led to charges that Morsi's powers turned him into a "new pharaoh."

The large turnout in Tuesday's protests — dubbed "The Last Warning" by organizers — signaled sustained momentum for the opposition, which brought out at least 200,000 protesters to Cairo's Tahrir Square a week ago and a comparable number on Friday to demand that Morsi rescind the decrees.

The huge scale of the protests have dealt a blow to the legitimacy of the new constitution, which Morsi's opponents contend allows religious authorities too much influence over legislation, threatens to restrict freedom of expression and opens the door to Islamist control over day-to-day life.

What the revived opposition has yet to make clear is what it will do next: campaign for a "no" vote on the draft constitution in a nationwide referendum set for Dec. 15, or call on Egyptians to boycott the vote.

Already, the country's powerful judges have said they will not take on their customary role of overseeing the vote, thus robbing it of much of its legitimacy.

Morsi was in the presidential palace conducting business as usual as the protesters gathered outside. He left for home through a back door as the crowds continued to swell, according to a presidential official who spoke on condition of anonymity because he was not authorized to speak to the media.

The official said Morsi left on the advice of security officials to head off "possible dangers" and to calm the protesters. Morsi's spokesman, however, said the president left the palace at the end of his normal work day, through the door he routinely uses.

The protest was peaceful except for a brief outburst when police used tear gas to prevent demonstrators from removing a barricade topped with barbed wire and converging on the palace.

Soon after, with the president gone, the police abandoned their lines and the protesters surged ahead to reach the palace walls. But there were no attempts to storm the palace, guarded inside by the army's Republican Guard.

Protesters also commandeered two police vans, climbing atop the armored vehicles to jubilantly wave Egypt's red, white and black flag and chant against Morsi. The protesters later mingled freely with the black-clad riot police, as more and more people flocked to the area to join the demonstration.

The protesters covered most of the palace walls with anti-Morsi graffiti and waved giant banners carrying images of revolutionaries killed in earlier protests. "Down with the regime" and "No to Morsi," they wrote on the walls.

"He isn't the president of all Egyptians, only of the Muslim Brotherhood," said protester Mariam Metwally, a postgraduate student of international law. "We don't feel like he is our president."

A giant poster emblazoned with an image of Morsi wearing a Pharaonic crown was hoisted between two street light posts outside the presidential palace. "Down with the president. No to the constitution," it declared.

"The scene at Itihadiya palace is a stab at the president's legitimacy and his constitutional declaration," opposition leader Hamdeen Sabahi told a private TV network. "The scene sends a message to the president that he is running out of time."

The massive gathering was reminiscent of the one outside the palace on Feb. 11, 2011 — the day authoritarian president Hosni Mubarak stepped down in the face of an 18-day uprising that ended his 29-year regime.

Shouts of "Erhal! Erhal!" — Arabic for "Leave! Leave!" — and "The people want to topple the regime!" rose up from the crowd, the same chants used against Mubarak. This time, though, they were directed at his successor, Egypt's first democratically elected president.

"The same way we brought down Mubarak in 18 days, we can bring down Morsi in less," Ziad Oleimi, a prominent rights activist, told the crowds using a loudspeaker.

In Alexandria, some 10,000 opponents of Morsi gathered in the center of the country's second-largest metropolis, chanting slogans against the leader and his Islamic fundamentalist group, the Muslim Brotherhood.

The protests fueled Egypt's worst political crisis since Mubarak's ouster, with the country clearly divided into two camps: Morsi, his Muslim Brotherhood and their ultraconservative Islamist allies, versus an opposition made up of youth groups, liberal parties and large sectors of the public.

Tens of thousands also gathered in Cairo's downtown Tahrir Square, miles away from the palace, to join several hundred who have been camping out there for nearly two weeks. There were other large protests around the city.

Smaller protests by Morsi opponents were staged in the Islamist stronghold of Assiut, as well as in Suez, Luxor, Aswan, Damanhour and the industrial city of Mahallah, north of Cairo.

"Freedom or we die," chanted a crowd of several hundred outside a mosque in Cairo's Abbasiyah district. "Mohammed Morsi, illegitimate! Brotherhood, illegitimate!" they yelled.

Earlier Tuesday, several hundred protesters also gathered outside Morsi's residence in an upscale suburb. "Down with the sons of dogs. We are the power and we are the people," they chanted.

Morsi, who narrowly won the presidency in a June election, appeared to be in no mood for compromise.

A statement by his office said he met Tuesday with his deputy, his prime minister and several top Cabinet members to discuss preparations for the referendum. The statement suggested business as usual at the palace, despite the mass rally outside its doors.

Asked why Morsi did not address the crowds, Muslim Brotherhood spokesman Mahmoud Ghozlan said the protesters were "rude" and included "thugs and drug addicts."

The Islamists responded to the mass opposition protests last week by sending hundreds of thousands of supporters into Cairo's twin city of Giza on Saturday and across much of the country. Thousands also besieged Egypt's highest court, the Supreme Constitutional Court.

The court had been widely expected to declare the constitutional assembly that passed the draft charter illegitimate and to disband parliament's upper house, the Shura Council. Instead, the judges went on strike after they found their building under siege by protesters.

Morsi's Nov. 22 decrees were followed last week by the constitutional panel rushing through the draft constitution in a marathon, all-night session without the participation of liberal and Christian members. Only four women, all Islamists, attended the session.

The charter has been criticized for not protecting the rights of women and minority groups, and many journalists see it as restricting freedom of expression. Critics also say it empowers Islamic religious clerics by giving them a say over legislation, while some articles were seen as tailored to get rid of the Islamists' enemies.

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Associated Press writer Maggie Michael contributed to this report.

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Japan's campaign starts, focus on economy, nuclear

TOKYO (AP) — Leaders for Japan's biggest political parties are kicking off the campaign for parliamentary elections to be held in less than two weeks with visits to nuclear crisis-hit Fukushima prefecture.

Nuclear energy and the economy are key issues in the Dec. 16 election, which is widely expected to send Prime Minister Yoshihiko Noda's unpopular Democratic Party of Japan to defeat after three years in power.

The opposition Liberal Democratic Party is leading in the polls, but is unlikely to win a majority of seats in the lower house of parliament.

The most likely outcome of the election is a coalition government whose makeup is far from clear.

Polls show more than 40 percent of voters don't know which party they'll support in the election.

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Additional copies of 'Lincoln' headed to theaters

LOS ANGELES (AP) — "Lincoln" is marching to more movie theaters.

Disney, which distributed the DreamWorks film, is making additional prints of director Steven Spielberg's historical saga starring Daniel Day-Lewis to meet an unexpected demand that has left some moviegoers in Alaska out in the cold.

"To say that we're encouraged by the results to date or that they've exceeded our expectations is an understatement," said Dave Hollis, head of distribution at the Walt Disney Co. "We're in the midst of making additional prints to accommodate demand and will have them available to our partners in exhibition by mid-December for what we hope will be a great run through the holiday and awards corridor."

The film, which opened in wide release Nov. 9 and has earned $83.6 million in North America so far, has been unavailable at some smaller venues, such as the Gross Alaska theaters in Juneau.

But the extra prints are coming a little too late to fit the movie into the five-screen Glacier Cinemas theater during the holiday season, said Kenny Solomon-Gross, general manager of the Gross Alaska, which runs two theaters in Juneau and one in Ketchikan, Alaska.

"When we had the room for 'Lincoln,' Disney didn't have a copy for us," Solomon-Gross said Monday.

His film lineup is pretty booked through the end of the year, and he probably can't screen "Lincoln" until after the first of the new year. Yes, the excitement over the film will have dimmed, but then the Academy Awards season will be stirring up, he said. That should kick up the buzz.

In the meantime, Solomon-Gross plans to head to Las Vegas this week and catch the film there.

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Follow AP Entertainment Writer Derrik J. Lang on Twitter at http://www.twitter.com/derrikjlang . Associated Press writer Rachel D'Oro in Anchorage, Alaska, contributed to this report.

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Fossil fuel subsidies in focus at climate talks

DOHA, Qatar (AP) — Hassan al-Kubaisi considers it a gift from above that drivers in oil- and gas-rich Qatar only have to pay $1 per gallon at the pump.

"Thank God that our country is an oil producer and the price of gasoline is one of the lowest," al-Kubaisi said, filling up his Toyota Land Cruiser at a gas station in Doha. "God has given us a blessing."

To those looking for a global response to climate change, it's more like a curse.

Qatar — the host of U.N. climate talks that entered their final week Monday — is among dozens of countries that keep gas prices artificially low through subsidies that exceeded $500 billion globally last year. Renewable energy worldwide received six times less support — an imbalance that is just starting to earn attention in the divisive negotiations on curbing the carbon emissions blamed for heating the planet.

"We need to stop funding the problem, and start funding the solution," said Steve Kretzmann, of Oil Change International, an advocacy group for clean energy.

His group presented research Monday showing that in addition to the fuel subsidies in developing countries, rich nations in 2011 gave more than $58 billion in tax breaks and other production subsidies to the fossil fuel industry. The U.S. figure was $13 billion.

The Paris-based Organization for Economic Cooperation and Development has calculated that removing fossil fuel subsidies could reduce carbon emissions by more than 10 percent by 2050.

Yet the argument is just recently gaining traction in climate negotiations, which in two decades have failed to halt the rising temperatures that are melting Arctic ice, raising sea levels and shifting weather patterns with impacts on droughts and floods.

In Doha, the talks have been slowed by wrangling over financial aid to help poor countries cope with global warming and how to divide carbon emissions rights until 2020 when a new planned climate treaty is supposed to enter force. Calls are now intensifying to include fossil fuel subsidies as a key part of the discussion.

"I think it is manifestly clear ... that this is a massive missing piece of the climate change jigsaw puzzle," said Tim Groser, New Zealand's minister for climate change.

He is spearheading an initiative backed by Scandinavian countries and some developing countries to put fuel subsidies on the agenda in various forums, citing the U.N. talks as a "natural home" for the debate.

The G-20 called for their elimination in 2009, and the issue also came up at the U.N. earth summit in Rio de Janeiro earlier this year. Frustrated that not much has happened since, European Union climate commissioner Connie Hedegaard said Monday she planned to raise the issue with environment ministers on the sidelines of the talks in Doha.

Many developing countries are positive toward phasing out fossil fuel subsidies, not just to protect the climate but to balance budgets. Subsidies introduced as a form of welfare benefit decades ago have become an increasing burden to many countries as oil prices soar.

"We are reviewing the subsidy periodically in the context of the total economy for Qatar," the tiny Persian gulf country's energy minister, Mohammed bin Saleh al-Sada, told reporters Monday.

Qatar's National Development Strategy 2011-2016 states it more bluntly, saying fuel subsides are "at odds with the aspirations" and sustainability objectives of the wealthy emirate.

The problem is that getting rid of them comes with a heavy political price.

When Jordan raised fuel prices last month, angry crowds poured into the streets, torching police cars, government offices and private banks in the most sustained protests to hit the country since the start of the Arab unrest. One person was killed and 75 others were injured in the violence.

Nigeria, Indonesia, India and Sudan have also seen violent protests this year as governments tried to bring fuel prices closer to market rates.

Iran has used a phased approach to lift fuel subsidies over the past several years, but its pump prices remain among the cheapest in the world.

"People perceive it as something that the government is taking away from them," said Kretzmann. "The trick is we need to do it in a way that doesn't harm the poor."

The International Energy Agency found in 2010 that fuel subsidies are not an effective measure against poverty because only 8 percent of such subsidies reached the bottom 20 percent of income earners.

The IEA, which only looked at consumption subsidies, this year said they "remain most prevalent in the Middle East and North Africa, where momentum toward their reform appears to have been lost."

In the U.S., environmental groups say fossil fuel subsidies include tax breaks, the foreign tax credit and the credit for production of nonconventional fuels.

Industry groups, like the Independent Petroleum Association of America, are against removing such support, saying that would harm smaller companies, rather than the big oil giants.

In Doha, Mohammed Adow, a climate activist with Christian Aid, called all fuel subsidies "reckless and dangerous," but described removing subsidies on the production side as "low-hanging fruit" for governments if they are serious about dealing with climate change.

"It's going to oil and coal companies that don't need it in the first place," he said.

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Associated Press writers Abdullah Rebhy in Doha, Qatar, and Brian Murphy in Dubai, United Arab Emirates, contributed to this report

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Karl Ritter can be reached at www.twitter.com/karl_ritter

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Marine awarded Navy's highest honor in rare public ceremony

CAMP PENDLETON, Calif. (AP) — Navy Secretary Ray Mabus on Monday honored four members of a Marine special operations team in a rare public ceremony for the covert forces.

In a ceremony at Camp Pendleton, Calif., Mabus awarded Marine Sgt. William Soutra Jr. the Navy Cross, the Navy's highest honor and the military's second highest honor, for tending to the wounded while guiding the platoon to safety during an attack in Afghanistan's Helmand Province in July 2010 that spanned over two days.

Three others on his team, including a Navy corpsman, were given Silver Stars.

Often the heroic actions of special operators are only known to each other and the leadership because of their covert work on classified missions.

"This is a chance to recognize people who don't get recognized much," Mabus said, adding that their actions show "just how incredibly capable" Marine special operators are.

Soutra was a canine handler with a Marine special operations team when they were ambushed. After the team's assistant leader was fatally wounded by an enemy explosive during the ambush, Soutra jumped into action, repeatedly running into the line of fire as he helped direct troops to defend themselves and fight off the enemy, Mabus said.

At one point, the 27-year-old Marine from Worchester, Mass., placed a tourniquet on a wounded commando, before dragging him to a ditch for cover. He worked tirelessly for more than an hour after the initial blast and helped carry casualties through the sporadic gunfire, officials said.

His military dog stayed attached to his side during the ordeal. The dog had to be put down more than a year ago because it had cancer.

Maj. James Rose, Staff Sgt. Frankie Shinost Jr. and Navy Corpsman Patrick Quill were given Silver Stars for their actions that day.

The four men called it a horrible day because they lost their element leader, Staff Sgt. Chris Antonik.

"Every day I think about Chris," said Soutra, calling him a close friend and great warrior.

Soutra vowed to try to carry on as the kind of warrior that would make Antonik proud.

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Vietnam War-era mortar shell blast kills 4 kids

HANOI, Vietnam (AP) — A mortar shell left from the Vietnam War has exploded in a southern village, killing four children and seriously injuring five other people.

Hieu Nghia village official Le Van Giang says three children aged 4 to 11 died at the scene Sunday afternoon and a 6-year-old boy died at the hospital. The blast seriously injured two other children and three men.

Giang said the shell exploded when the children who found the shell from bamboo brush were playing with it. A villager found the shell five years ago when dredging a canal.

The village in Vinh Long province was a communist stronghold during the war.

Vietnamese government figures show unexploded ordnance have killed more than 42,000 people since the war ended in 1975.

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Young down by boardwalk for benefit show

NEW YORK (AP) — Neil Young said Sunday that he couldn't see performing in the area devastated by Superstorm Sandy without doing something to help people who were affected by it.

Young and his longtime backing band, Crazy Horse, will hold a benefit concert for the American Red Cross' storm relief effort Thursday at the Borgata Hotel Casino & Spa in Atlantic City. The New Jersey coastline areas were hit hard by the storm in late October.

People in the New York area who suffered damage in the storm have been supporting him for 40 years, he said.

"I couldn't see coming back here and just playing and have it be business as usual," he said. Young is touring in the area, with concerts scheduled for Monday in Brooklyn and Tuesday in Bridgeport, Conn.

Minimum ticket prices for the standing-room show in Atlantic City will be $75 and $150, although Young notes there's no maximum. He hopes to raise several hundred thousand dollars for the Red Cross.

Young said he was invited to join the Dec. 12 benefit at New York's Madison Square Garden that will feature Bruce Springsteen, Paul McCartney, the Who, Kanye West and others, but had other obligations. Besides, there's enough star power there, he said.

"It wasn't going to make much difference whether I was there or not, so I decided to go someplace where I could make a difference," he said.

Young performed at a televised benefit in 2001 following the Sept. 11 terrorist attacks, memorably covering John Lennon's "Imagine."

Fans can expect a two-hour plus rock show on Thursday with opening band Everest. No special guests are planned, although Young issued an invitation to "anyone who wants to come in and play with us that we know and we know can play."

It's hard to resist wondering whether Young's epic "Like a Hurricane" will make it onto the set list, given the occasion.

"Anything's possible," Young said. "We have the equipment."

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Asperger's dropped from revised diagnosis manual

CHICAGO (AP) — The now familiar term "Asperger's disorder" is being dropped. And abnormally bad and frequent temper tantrums will be given a scientific-sounding diagnosis called DMDD. But "dyslexia" and other learning disorders remain.

The revisions come in the first major rewrite in nearly 20 years of the diagnostic guide used by the nation's psychiatrists. Changes were approved Saturday.

Full details of all the revisions will come next May when the American Psychiatric Association's new diagnostic manual is published, but the impact will be huge, affecting millions of children and adults worldwide. The manual also is important for the insurance industry in deciding what treatment to pay for, and it helps schools decide how to allot special education.

This diagnostic guide "defines what constellations of symptoms" doctors recognize as mental disorders, said Dr. Mark Olfson, a Columbia University psychiatry professor. More important, he said, it "shapes who will receive what treatment. Even seemingly subtle changes to the criteria can have substantial effects on patterns of care."

Olfson was not involved in the revision process. The changes were approved Saturday in suburban Washington, D.C., by the psychiatric association's board of trustees.

The aim is not to expand the number of people diagnosed with mental illness, but to ensure that affected children and adults are more accurately diagnosed so they can get the most appropriate treatment, said Dr. David Kupfer. He chaired the task force in charge of revising the manual and is a psychiatry professor at the University of Pittsburgh.

One of the most hotly argued changes was how to define the various ranges of autism. Some advocates opposed the idea of dropping the specific diagnosis for Asperger's disorder. People with that disorder often have high intelligence and vast knowledge on narrow subjects but lack social skills. Some who have the condition embrace their quirkiness and vow to continue to use the label.

And some Asperger's families opposed any change, fearing their kids would lose a diagnosis and no longer be eligible for special services.

But the revision will not affect their education services, experts say.

The new manual adds the term "autism spectrum disorder," which already is used by many experts in the field. Asperger's disorder will be dropped and incorporated under that umbrella diagnosis. The new category will include kids with severe autism, who often don't talk or interact, as well as those with milder forms.

Kelli Gibson of Battle Creek, Mich., who has four sons with various forms of autism, said Saturday she welcomes the change. Her boys all had different labels in the old diagnostic manual, including a 14-year-old with Asperger's.

"To give it separate names never made sense to me," Gibson said. "To me, my children all had autism."

Three of her boys receive special education services in public school; the fourth is enrolled in a school for disabled children. The new autism diagnosis won't affect those services, Gibson said. She also has a 3-year-old daughter without autism.

People with dyslexia also were closely watching for the new updated doctors' guide. Many with the reading disorder did not want their diagnosis to be dropped. And it won't be. Instead, the new manual will have a broader learning disorder category to cover several conditions including dyslexia, which causes difficulty understanding letters and recognizing written words.

The trustees on Saturday made the final decision on what proposals made the cut; recommendations came from experts in several work groups assigned to evaluate different mental illnesses.

The revised guidebook "represents a significant step forward for the field. It will improve our ability to accurately diagnose psychiatric disorders," Dr. David Fassler, the group's treasurer and a University of Vermont psychiatry professor, said after the vote.

The shorthand name for the new edition, the organization's fifth revision of the Diagnostic and Statistical Manual, is DSM-5. Group leaders said specifics won't be disclosed until the manual is published but they confirmed some changes. A 2000 edition of the manual made minor changes but the last major edition was published in 1994.

Olfson said the manual "seeks to capture the current state of knowledge of psychiatric disorders. Since 2000 ... there have been important advances in our understanding of the nature of psychiatric disorders."

Catherine Lord, an autism expert at Weill Cornell Medical College in New York who was on the psychiatric group's autism task force, said anyone who met criteria for Asperger's in the old manual would be included in the new diagnosis.

One reason for the change is that some states and school systems don't provide services for children and adults with Asperger's, or provide fewer services than those given an autism diagnosis, she said.

Autism researcher Geraldine Dawson, chief science officer for the advocacy group Autism Speaks, said small studies have suggested the new criteria will be effective. But she said it will be crucial to monitor so that children don't lose services.

Other changes include:

—A new diagnosis for severe recurrent temper tantrums — disruptive mood dysregulation disorder. Critics say it will medicalize kids' who have normal tantrums. Supporters say it will address concerns about too many kids being misdiagnosed with bipolar disorder and treated with powerful psychiatric drugs. Bipolar disorder involves sharp mood swings and affected children are sometimes very irritable or have explosive tantrums.

—Eliminating the term "gender identity disorder." It has been used for children or adults who strongly believe that they were born the wrong gender. But many activists believe the condition isn't a disorder and say calling it one is stigmatizing. The term would be replaced with "gender dysphoria," which means emotional distress over one's gender. Supporters equated the change with removing homosexuality as a mental illness in the diagnostic manual, which happened decades ago.

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

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At least 8 dead in Japanese highway tunnel collapse

At least eight people have been confirmed dead, after a highway tunnel in central Japan partially collapsed Sunday morning, sparking a fire, and trapping three cars inside.

Yamanashi police say the charred remains of five victims were pulled from a rental van nearly seven hours after the accident at the Sasago Tunnel, 50 miles west of the capital city. Late Sunday night, search crews found the driver of another truck dead, crushed under debris, about a mile from the tunnel exit.

The driver had called his company earlier in the day, to say he was trapped inside the tunnel, but heavy smoke and fears of another collapse hampered rescue efforts, according to broadcaster NHK.

Two other victims were killed inside a separate car.

Video from surveillance cameras inside the tunnel showed concrete slabs, as many as 150, caved in, with cars flattened underneath. Aerial images of the scene showed black smoke billowing out of the tunnel.

Witnesses report a frantic scene following the accident. More than 20 cars including a tour bus were passing through at the time, but many passengers managed to escape the flames.

"The ceiling just caved in, so I couldn't tell if it was dust rising or smoke," one witness told NHK. "I wasn't able to see anything in front of me."

The collapse occurred about 2 miles from the exit of the roughly 3 mile long tunnel, bound for Tokyo, according to Central Nippon Expressway or NEXCO, which operates the tunnel. Concrete ceiling panels came crashing down on cars passing through, triggering a fire.

Firefighters and rescue crews were dispatched to the scene, but heavy smoke slowed efforts early in the day.

Sunday afternoon, they temporarily suspended the search, fearful of another collapse, but emergency crews resumed efforts in the evening, in search of those still unaccounted for.

The Sasago tunnel is located on the Chuo Expressway, a major thoroughfare that runs from Tokyo to the city of Nagoya. It was built in 1977 and had just passed a routine inspection in September, according to NEXCO officials.

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