Unless the Trump administration and Republicans in Congress act quickly, millions of working Americans could lose access to their health insurance at the end of this year. Among the most affected will be small businesses and middle-income earners — many of whom, ironically, live in congressional districts that vote Republican.

An estimated 4.7 million small business owners and self-employed workers relied on the Affordable Care Act Marketplace to obtain health insurance in 2023, according to the latest figures from the Treasury Department. But the tax credits these businesses use to offset their health insurance costs are set to expire at the end of December — and neither the Trump White House nor Republicans in Congress are poised to do anything about it.

That will inflict real pain on millions of Americans and hand Democrats an issue they can use to bludgeon Republicans in the midterms. Health care remains one of Democrats’ few potent weapons.

The reason for the December deadline is that, in 2021, Congress raised the income levels of people who could receive the enhanced tax credits at the urging of President Joe Biden. The Inflation Reduction Act extended the subsidies until 2025. The changes came with a hefty federal price tag — estimated at $335 billion over 10 years — but they also led to record-high enrollment in the ACA Marketplaces. In 2024, more Americans had health insurance than ever before.

Unfortunately for Biden, most of the public heard little about this program, according to KFF, a nonprofit health policy research organization. Half of the recipients are not even aware their health insurance is subsidized with federal dollars.

And many of the beneficiaries are Republican. According to a review by KFF, 56% of ACA Marketplace enrollees live in congressional districts represented by Republicans and 76% of enrollees are in states won by President Donald Trump in the 2024 election.

Should the credits disappear, states will see a $34 billion reduction in state gross domestic product, lose an estimated 286,000 jobs — nearly half of them in hospitals, doctors’ offices and pharmacies — and state and local tax revenue will decline by $2.1 billion, according to a report released in March by the Commonwealth Fund and the George Washington University Milken Institute School of Public Health.

The hardest-hit states would be those that have not expanded Medicaid, where residents depend more on marketplace subsidies — Alabama, Florida, Georgia, Indiana, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming. All voted for Trump in 2024.

For the people who rely on the subsidies, the impact will be immediate, painful and disruptive. Out-of-pocket premiums for ACA marketplace enrollees will increase by an average of more than 75%, according to an estimate by the Petersen-KFF Health System Tracker. Middle-income families (calculated as $103,280 for a family of three) will lose up to $5,370 a year in premium tax credits, forcing many to go uninsured.

“There’s not a lot of gray area here,’’ said Mary Mayhew, CEO of the Florida Hospital Association. “We will see our uninsured rates increase significantly for individuals who are largely working.”

Mayhew is the former secretary of the Florida Agency of Health Care Administration, the former commissioner of the Maine Department of Health and Human Services, and worked in the first Trump administration’s Medicaid office before coming to Florida. For years, she fiercely opposed the expansion of Medicaid under Obamacare, arguing that the federal government shouldn’t be involved in subsidizing private insurance.

Now, as head of Florida’s largest hospital association, Mayhew has changed her mind. Her association has teamed up with other business groups to form Florida Conservatives for Affordable Care, a coalition lobbying Congress to extend the subsidies.

“It really does come down to, if not this, then what?’’ Mayhew told me. “The market has changed” and without the federal program, it would be “incredibly difficult for a small business to purchase health insurance coverage for their employees.”

The about-face over the ACA from many business groups is striking, but their argument is no surprise, said Leighton Ku, director of the Center for Health Policy Research at the George Washington University Milken Institute School of Public Health. The marketplaces were designed to appeal to conservatives by allowing people to buy health insurance through private plans.

Since 2014, when the marketplace launched, the ACA has halved the number of people without insurance, according to the most recent data. Businesses now have the flexibility to hire part-time and seasonal workers who can qualify for individual coverage. Entrepreneurs, early retirees and young adults are guaranteed coverage — and often receive it with federal subsidies depending on their income level.

Mayhew says she is urging Congress to “set aside the polarizing politics of the Affordable Care Act” and realize that small businesses are in better shape now than they were 15 years ago because they have better access to health insurance.

“You can’t simply be ‘no’ to everything,’’ she says. “This is working.”

That’s good advice. Will Republicans take it? If not, they may be handing Democrats a Christmas gift.

Mary Ellen Klas is a politics and policy columnist for Bloomberg Opinion. A former capital bureau chief for the Miami Herald, she has covered politics and government for more than three decades.

By Alex Brown, Stateline.org

Wildland firefighters were stunned when federal immigration authorities last week raided an active wildfire response in Washington state, arresting two firefighters and sidelining crews for hours.

Wildfire veterans say the operation was nearly unprecedented, a breach in longstanding protocol that federal agents don’t disrupt emergency responders to check immigration status.

Worse, many wildfire veterans believe the management team overseeing the fire crews played a key role in handing over the firefighters to immigration authorities.

Stateline spoke to nearly a dozen firefighters, agency staffers and contractors familiar with the incident, who shared their belief that the top officials assigned to the fire deployed the crews to a remote location under false pretenses so federal agents could check their immigration status. Most of them spoke privately for fear of retaliation.

The raid has reverberated among fire crews, agency leaders and contractors. Wildfire veterans say the arrests have stoked fear and distrust among firefighters on the ground. They worry that crews may be scared to deploy if they may become a target for immigration raids.

“There’s really no way [the wildfire management team] could not have been involved,” said Riva Duncan, a former wildland fire chief who served more than 30 years with the U.S. Forest Service. “We’re all talking about it. People are wondering if they go on a fire with this team, if that could happen to them.”

Since the incident became public, the wildfire world has been abuzz with anger at that team — California Interagency Incident Management Team 7. Made up of federal, state and local fire professionals, the team was assigned to oversee the response to the Bear Gulch fire, which has burned 9,000 acres in and around Olympic National Park in Washington state.

One firefighter who was present at the raid said he is convinced that Team 7 leaders sent their crews into a trap.

“I felt beyond betrayed,” said the firefighter, who requested anonymity to protect his career. “What they did was messed up. They’d been talking in their briefings about building relationships and trust. For them to say that and then go do this is mind-boggling. It boiled my blood.”

Team 7 Incident Commander Tom Clemo, in an email, declined to comment, citing an active investigation. Tom Stokesberry, the team’s public information officer, did not immediately respond to requests for comment.

According to daily Incident Action Plans filed by Team 7 and posted online, the crews had previously been digging holding lines, working to protect structures and conducting mop-up work. The two crews targeted by federal agents had not been assigned to work together in the days leading up to the raid.

Then, on Aug. 27, both crews — workers from private companies contracted to help fight the fire — were told to deploy to a staging area where they would cut firewood for the local community. The firefighter who was present at the raid told Stateline that a division supervisor told the crews he would meet them at the site, but never showed up.

After arriving at the site, the firefighter said, the crews found piles of logs, seemingly from a timber operation. Not wanting to damage a logging company’s property, they waited for a management team leader to show up with further instructions.

After an hour, unmarked law enforcement vehicles pulled up to the site and federal officials began questioning the firefighters. Duncan, the former Forest Service firefighter, said immigration agents would not have been able to access the site without help from Team 7 leaders.

“Fire areas are officially closed, very secure and there are roadblocks,” she said. “Somebody would have had to tell these agents how to get there.”

In a news release, U.S. Customs and Border Protection said its agents assisted with an investigation led by the federal Bureau of Land Management. While the agency’s release did not mention the nature of the investigation, multiple wildfire sources said the feds claimed they had uncovered fraud on time cards submitted by the crews.

Table Rock Forestry Inc., an Oregon-based company whose crew was one of the two at the scene, was allegedly subjected to the raid due to a half-hour discrepancy on a time sheet, said Scott Polhamus, secretary of the Organization of Fire Contractors and Affiliates. Table Rock Forestry is a member of the fire contractors’ group.

Multiple wildfire veterans said that time card discrepancies are not uncommon at wildfires, where crews work long days and it’s not always clear if lunch breaks or errands in town count toward working hours. Such mix-ups are typically sorted out between organizational leaders. Calling law enforcement in such a scenario is almost unheard of.

“This is not the first time a crew has been called on the carpet for maybe padding their time a bit,” Duncan said. “You deal directly with the company. It’s just absolutely mind-boggling to treat it as a criminal issue.”

After about five minutes discussing the time card issue, according to the firefighter who was present at the raid, federal agents spent the next three hours checking each firefighter’s immigration status.

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The Customs and Border Protection news release announcing the immigration arrests made no mention of time sheets or any evidence that the investigation had turned up fraud. It did state that the two companies whose crews were raided had their contracts terminated by the government.

Polhamus, with the fire contractors’ group, said that claim is false. While the crews were demobilized and sent home, the feds have not actually ended the companies’ contracts or ability to accept future deployments.

A Customs and Border Protection public affairs specialist did not immediately respond to questions about the investigation, the alleged fraud or federal agents’ coordination with Team 7.

The Washington State Department of Natural Resources, the state’s lead wildfire response agency, said federal officials did not notify their state counterparts about the investigation.

“DNR was not informed of the incident until well after the fact,” said Ryan Rodruck, wildfire on-call public information officer with the agency.

Rodruck noted that the fire response was under the jurisdiction of the U.S. Forest Service. Press officers with the Forest Service did not immediately respond to requests for comment.

Multiple wildfire sources said the crews would not have been sent to the staging area where they were ambushed without the knowledge of top leaders on the fire’s management team.

The two crews that were raided have a diverse mix of firefighters, many of them Hispanic. One of the crews has many foreign workers who are legally in the country on H-2B visas. Duncan, the former Forest Service firefighter, said it was likely not a coincidence that two crews with many brown-skinned members were targeted in the raid.

Two of the firefighters were arrested, federal officials said, for being in the country illegally.

One of the firefighters who was arrested is represented by Innovation Law Lab, an Oregon-based legal group that defends refugees and immigrants. Isa Peña, the group’s director of strategy, said the Department of Homeland Security has not revealed the whereabouts of their client.

The firefighter, who Peña declined to name, has been in the U.S. since he was four years old and served as a firefighter for the past three years. Immigration advocates are alarmed that the raid was potentially arranged by California Interagency Incident Management Team 7, the leaders charged with overseeing the wildfire response.

“There certainly is concern if that is the case that individuals are being handed over to immigration as they’re trying to keep our communities safe,” Peña said. “Conducting immigration enforcement while brave members of our community are risking their lives to protect us is really disgusting.”

Several wildland fire veterans also noted that the raid took place on Team 7’s final day in charge of the fire response, hours before a Washington team rotated in to take command. The California team headed home and left the new team to face the media scrutiny and angry firefighters in camp.

“If you’ve got ICE teams pulling your contractors out, you’d want to cut and run as soon as you can,” Polhamus said.

On a forum for wildland fire professionals on the social media platform Reddit, many expressed anger at Team 7. Firefighters also took issue with the assertion, shared by federal immigration officials, that the raid did not disrupt firefighting operations.

“It’s total bulls***,” said Duncan, the former Forest Service firefighter. “Whoever made that statement doesn’t understand the work. To take two crews off of a fire that’s only 13% contained, that seems ridiculous at that point in a fire. That does seem very unusual.”

Many wildfire veterans said that conducting a raid at the site of an active wildfire was reckless and irresponsible.

“Having people on the line that you don’t expect to be there is an issue,” said Polhamus, with the fire contractors’ group. “When you need crews and you are taking resources to check them for immigration status, we can all think of better ways to address that.”

Duncan said she’s spoken with firefighters still assigned to the Bear Gulch fire who are disgusted with the situation and want to leave.

“The three principal wildland fire values are duty, respect, integrity,” she said. “Utmost in that is taking care of your people. If you can’t trust the people you’re working with when things get hairy, that’s a concern.”

In Washington and Oregon, elected leaders have decried the raids and are pushing for more information on the status of the firefighters who were arrested. Federal immigration officials have said little since the news release announcing the arrests.

Stateline reporter Alex Brown can be reached at abrown@stateline.org

©2025 States Newsroom. Visit at stateline.org. Distributed by Tribune Content Agency, LLC.

National Blood Donor Day is Sept. 4. If you ever wanted to do something to help people, but didn’t have money to donate or time to volunteer, giving blood is another way to give back that can potentially save a life — maybe even more than one.

In 2025, giving blood is less painful and more inclusive than you might remember.

More members of the LGBTQ+ community are now welcome to donate blood after the U.S. Federal Drug Administration updated blood donation guidelines in 2023. And just this year, the oft-dreaded finger stick was replaced with a sensor slipped on to a finger to measure a donor’s hemoglobin, the protein in blood that carries oxygen.

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Want to know your blood type? A donation will reveal that information. And the Red Cross now provides free A1C testing, which is used to screen for diabetes and prediabetes.

“One in 10 people in our country have diabetes but nearly a quarter are undiagnosed — and some 80% of those living with prediabetes are also unaware of having it,” Doreen Thomann-Howe, CEO for the American Red Cross in Greater New York, said in a statement. “When offering A1C screening previously in March, we found that over half of donors were unaware of their own A1C levels.”

There’s no substitute for blood, and research continues into the production of artificial blood. Anyone in medical need can benefit from donated blood, from a cancer patient, to an accident victim, to someone undergoing surgery.

“The need for blood is constant, and every two seconds someone in the United States needs blood. Although about 62% of the U.S. population is eligible to give blood, only about 3% donate,” Thomann-Howe said. “A single blood donation can help save more than one life.”

Blood donations plummeted during the pandemic, which is when I started regularly donating blood. I am a two-gallon blood donor with the American Red Cross, which means I have donated blood at least 16 times over my lifetime and have two pins to show for it.

A pin for every gallon of blood I’ve donated to the American Red Cross. (photo by Darleene Powells)

Interested in donating? There are a few things to know before you show up at a blood drive.

Connect

The American Red Cross has a website and a smartphone app, where you can make an appointment at your nearest blood drive site, see where your donated blood goes, and keep track of your past donations. I always make an appointment to donate blood, but other organizations like hospitals may allow walk-ins at their blood drives.

Prepare

The website and app will also be where you complete the RapidPass, a health screening questionnaire, prior to your appointment.

The day before your appointment, drink plenty of water and get a good night’s rest. Avoid rushing to your appointment — I was once in such a hurry, my blood pressure was too high to donate. Remember to bring photo identification.

Feel good

The American Red Cross provides both salty and sweet snacks, water and juices for donors after they give blood. (photo by Darleene Powells)

After your donation, the Red Cross provides snacks, water and juice to help you replenish your fluids. Take advantage of the refreshments and make sure to take it easy after your donation. I’ve also been admonished not to skip any meals after giving blood.

And don’t forget to feel good about your good deed. You may have helped save a life.

A 14-year-old student was found with a gun during the first day of the school year at a St. Paul high school Tuesday, according to police.

Police were called to Johnson Senior High School on Arcade Street at 9:30 a.m.

The school received a tip that a student may have brought a weapon to school, Principal Jamil Payton wrote in an email that will be sent to parents Tuesday.

“During a staff search conducted by one of our assistant principals, interventionist, and school support liaison (SSL), a gun was found,” he wrote. “No one was injured.”

Police responded to the school, and found staff had the teen and the firearm secured, said Alyssa Arcand, a St. Paul police spokeswoman. The handgun was unloaded when police recovered it.

Officers booked the teen into the Ramsey County Juvenile Detention Center.

“I understand this news can be extremely upsetting, especially on the first day of school,” Payton wrote. “At the same time, I want to call out that our safety protocols worked as intended.”

An investigation is underway, according to Arcand.

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