By ALI SWENSON and OBED LAMY, Associated Press

MINOOKA, Ill. (AP) — Bill Swick has a rare degenerative brain disease that inhibits his mobility and speech. Instead of the hassle of traveling an hour to a clinic in downtown Chicago to visit a speech therapist, he has benefited from virtual appointments from the comfort of his home.

But Swick, 53, hasn’t had access to those appointments for the last month.

Bill Swick looks at his wife Martha Swick at their home in Minooka, Ill., Friday, Oct. 24, 2025. (AP Photo/Nam Y. Huh)

The federal government shutdown, now in its fifth week, halted funding for the Medicare telehealth program that pays his provider for her services. So, Swick and his wife are practicing old strategies rather than learning new skills to manage his growing difficulties with processing language, connecting words and pacing himself while speaking.

“It’s frustrating because we want to continue with his journey, with his progress,” 45-year-old Martha Swick, a caregiver for her husband since his diagnosis three years ago, said during an interview at their home in Minooka, Illinois. “I try to have all his therapy and everything organized for him, to make his day easier and smoother, and then everything has a hitch, and we have to stop and wait.”

Their experience has become common in recent weeks among the millions of patients with Medicare fee-for-service plans who count on pandemic-era telehealth waivers to attend medical appointments from home.

With Congress unable to agree on a deal to fund the government, the waivers have lapsed, even with support from Republicans and Democrats. As a result, medical providers are deciding whether they can continue offering telehealth services without the guarantee of reimbursement or whether they need to halt virtual visits altogether.

That’s left a patient population of mostly older adults with fewer options to seek specialists or get help when they can’t physically travel far from home.

Bill Swick, right, looks around while study with his wife Martha Swick at their home in Minooka, Ill., Friday, Oct. 24, 2025. (AP Photo/Nam Y. Huh)

Swick, whose corticobasal degeneration causes symptoms similar to Parkinson’s disease, can’t feed or dress himself anymore and struggles with balance and walking. Add on the logistical nightmare of driving to the city in traffic, and in-person speech therapy appointments aren’t a worthwhile ordeal for him and his wife.

But missing even a few appointments can impede progress for patients with dementia and other degenerative conditions who depend on continuity of care, experts said.

It “feels like you’re taking a step back,” Swick said in the interview.

A temporary pause, with significant impact

Before the COVID-19 pandemic, Medicare only paid for virtual medical appointments under narrow circumstances, including in designated rural areas and when patients logged in from eligible sites, like hospitals and clinics.

That changed in 2020, when Trump’s first administration dramatically expanded telehealth coverage in response to the public health emergency. Medicare started reimbursing a wide range of telehealth visits, stripping the geographic requirement, and allowing patients to take calls from their homes.

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Congress has routinely extended the telehealth flexibilities and was poised to do so again before their Sept. 30 expiration. But when budget negotiations stalled and the government shut down Oct. 1, the vote never happened, leaving the program temporarily unfunded.

With more than 4 million Medicare fee-for-service beneficiaries using telehealth in the first half of 2025, according to Brown University’s School of Public Health, the pause has had a major impact on an already vulnerable population.

Swick’s speech therapy services are provided by the Chicago-area business Memory and Aphasia Care. Owner Becky Khayum said many of her clients are in different cities and states and sought her therapists out because they specialize in frontal temporal dementias.

“Now suddenly without telehealth services, they do not continue to have the support to participate in those activities that are so important to them,” Khayum said. “The risk is we could see social withdrawal; we could see depression and anxiety increased.”

Virtual visits can also be useful in different areas of medicine. Dr. Faraz Ghoddusi, a family medicine provider in Tigard, Oregon, said he uses telehealth to check in and help his patients manage their conditions, like diabetes and chronic lung disease. He said that in the current Medicare telehealth pause, one of his patients wasn’t having regular check-ins and ended up in the emergency room.

Susan Collins, 73, in Murrieta, California, said Medicare-reimbursed telehealth appointments were a “tremendous relief” to her when she was a full-time caregiver for her late husband, Leo. Before he died last year from progressive supranuclear palsy, a rare brain disorder, she struggled to lift him from his wheelchair in and out of the car for his in-person doctor visits 60 miles from their home.

“He was much safer at home,” Collins said, noting that telehealth was a useful resource when her husband needed a medication or symptom consultation but not a complete physical exam.

Doctors respond differently, leaving a patchwork

The latest guidance from the Centers for Medicare and Medicaid Services does not ban medical providers from providing telehealth services during the lapse – but it stops short of promising they’ll be reimbursed if they do.

In response, providers are deciding whether they can absorb the risk of continuing care without assurance that they’ll be paid for it when the government reopens.

Khayum in Illinois said she had to stop providing telehealth services to Medicare patients because her small business couldn’t handle the volatility of potentially losing out on payments. Ghoddusi, the family medicine provider, said his Oregon practice is honoring telehealth appointments made before Oct. 1 but not scheduling additional ones for Medicare patients until the funding is restored.

Genevieve Richardson, owner of a speech pathology business in Austin, Texas, has stopped providing telehealth services to her Medicare clients who are spread across the country. She has been referring them to outpatient clinics in their areas who can provide stopgap services in person.

Major hospitals are also grappling with whether to provide virtual care to Medicare patients. Dr. Helen Hughes, medical director of the Office of Telemedicine at Johns Hopkins Medicine, said the hospital initially continued the care, but paused scheduling more Medicare telehealth visits as of Oct. 16 as the shutdown continued.

She said the uncertainty surrounding the waivers has been “a total roller coaster.”

The congressional stalemate persists

The government shutdown is in its fifth week with no clear end on the horizon. Meanwhile, Medicare telehealth flexibilities and a separate Medicare program offering patients hospital-level care at home both remain paused.

Mei Kwong, executive director of the Center for Connected Health Policy, said the simplest solution to renewing the telehealth waivers would be for Congress to vote separately on them.

The hands of federal health care administrators “are kind of tied,” she said. “So, you really do need Congress to act.”

But with lawmakers divided and looking for leverage, hopes for such action are low.

Martha Swick, practicing word exercises with her husband in their home on a recent morning, said if a solution isn’t found soon, “my resource collection is going to run out.”

“I’m just doing what I’m able to at home as a wife and a caregiver,” she said. “But eventually I’m really going to need those appointments to come back.”

Swenson reported from New York.

St. Paul voters heading to the polls Nov. 4 will see a ballot question on an operating levy for St. Paul Public Schools that would increase the district’s per-pupil revenue.

Here’s what that means, why it’s on the ballot and what its approval could mean for property owners.

What is on the ballot?

Voters will be asked to vote yes or no on an increase to the district’s general revenue by $1,073 per pupil for 10 years, beginning with taxes payable in 2026. The result will cost the average St. Paul homeowner — with the median home valued at $289,200 — $309 per year, or $26 per month. The 10-year tax is subject to increase with inflation.

The ballot language will read:

“The board of Independent School District No. 625 (Saint Paul), Minnesota has proposed to increase the School District’s general education revenue by $1,073 per pupil, subject to an annual increase at the rate of inflation. The proposed new referendum revenue authorization would be first levied in 2025 for taxes payable in 2026 and applicable for ten (10) years unless otherwise revoked or reduced as provided by law.”

What does that mean?

If approved, the levy would raise $37.2 million annually for 10 years for St. Paul Public Schools, adjusted each year for inflation.

The funds would become part of the district’s general fund, which covers staff salaries and benefits, utilities and maintenance, transportation, curriculum, classroom equipment and administrative costs.

Previous levies

Voters approved similar requests for additional funding in 2018, 2012 and 2006. The 2018 levy gave the district $1,180 per student, or $18.6 million per year plus inflation, in new revenue. The 2018 levy — a 10-year levy — wasn’t earmarked for specific projects, but was meant to protect existing programs from further cuts while helping to pay for a district-wide strategic plan.

The levy referendum on the ballot in November would not revoke and replace the 2018 approved levy, which currently provides $1,167 per student, but will add onto it, according to Tom Sager, the district’s executive chief of financial services. Under state law, the school board could then choose to approve a one-time renewal of the 2018 levy as it’s set to expire without needing to bring it ahead of voters.

How much more will homeowners pay?

While the average St. Paul homeowners with a median-value home would see a $309 per year, or $26 per month, increase in their property taxes if the levy is approved, property owners won’t know the total changes to their property taxes for next year until city, county and school district levies are finalized in December.

How much to expect with city, county and school levies?

If the proposed city, county and school district levies are approved, including the special school district referendum, homeowners in St. Anthony Park, Battle Creek, Sunray, Highwood and downtown St. Paul would see their property taxes go up the least of any neighborhoods in the city, percentage-wise, while still seeing hikes of several hundred dollars.

Homeowners in the North End, Payne-Phalen, Thomas-Dale/Frogtown and the West Side neighborhoods would see their property taxes go up the most percentage-wise.

St. Paul schools levy for 2026

In September, the St. Paul school board approved a property tax levy at 1.98% less than the previous year as part of an annual process. That number will be finalized in December, but cannot be raised any higher. The tax is for 2026. Impacts on individual homeowners will depend on property values and doesn’t guarantee a 1.98% decrease on their property taxes that go to the district.

Why is this question on the ballot?

Without additional funding from the proposed levy, district officials say they expect to make at least $37 million budget cuts for the 2026-27 school year. If approved by voters, the increase will generate approximately $37.2 million per year in additional revenue.

The school board approved a $1 billion budget in June for 2026 with an estimated $51.1 million budget shortfall, which the district planned to cover using $35.5 million in reserve funds and $15.6 million in budget cuts and new revenue, including funds from the levy.

Budget reductions for 2026 have mainly come from cuts in the district’s central office departments, which make up 8% of the district’s total budget.

Funding from the proposed levy would help maintain programming such as arts and music, college- and career-readiness and language and culture initiatives, according to SPPS Superintendent Stacie Stanley.

Transportation, security and academic support services also face reductions if the district is not able to find additional revenue, according to district officials. However, anything is on the table for potential cuts, they say.

Further background

Local property taxes account for around 20% of the SPPS budget and the district currently spends more than $23,000 per pupil each year.

District officials attribute its budget shortfall to state funding not keeping pace with inflation in the past 20 years as well as increased expenses.

If state funding kept pace with inflation each year since 2003, the district would receive $1,470 more per student than it currently does, or approximately $50 million per year, according to district officials.

There is also uncertainty around potential cuts in federal funding and other revenue losses. Dropping enrollment, which is forecasted based on demographic trends, could add additional financial stress to the district, which receives state funding per pupil.

St. Paul schools officials have worked hard to get the word out on the levy referendum, using tax dollars to do so.

For more information on the 2025 election, including how to vote and information on candidates and ballot questions, go to twincities.com/news/politics/elections.

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Chinda Gregor’s first memory is of the jungles in her native Cambodia where she hid with her mother from the genocidal Khmer Rouge regime, which seized power as the American war in neighboring Vietnam entered its final days in 1975.

After narrowly escaping execution, the pair fled the country after the regime fell nearly four years later. They joined thousands of other refugees from Southeast Asia who immigrated to Minnesota in the wake of the Vietnam War.

Fifty years after the fall of Saigon, their stories will be highlighted during a two-day commemoration of the war’s end at Union Depot in St. Paul this weekend.

“I really want people to know why the Southeast Asian community is here,” said Gregor, who is now a teacher at Bloomington Public Schools. “The Cambodian genocide happened because of the Vietnam War.”

This weekend’s commemoration, which was organized by the Minnesota Humanities Center and the Minnesota Historical Society, will weave together the distinct yet related experiences of four local Southeast Asian communities — Hmong, Lao, Cambodian and Vietnamese — with those of U.S. military veterans to tell the complex story of the war and its aftermath.

“It still reverberates in people’s lives here in Minnesota and throughout the country,” MHC CEO Kevin Lindsey said of the Vietnam War. “You see people still carrying some of the scars.”

Two days of events

This weekend’s free events will feature performances by Hmong, Lao, Cambodian and Vietnamese dancers, musicians and storytellers. Food vendors also will be selling Southeast Asian cuisine.

The programming will run from noon to 7 p.m. on Saturday and 10 a.m. to 5 p.m. Sunday. A full schedule can be found on the MHC website.

MHC and MNHS brought together members of four local Southeast Asian communities and U.S. military veterans to help plan the weekend’s events.

Among them was Larry Johnson, who served as an Army medic in Germany during the Vietnam War and now volunteers with the Minnesota-based Veteran Resilience Project.

Johnson said he hopes the commemoration will raise awareness of the service of Southeast Asian veterans who fought alongside U.S. troops during the war but were long denied the recognition and benefits afforded to American service members.

“They’re still fighting for that recognition,” Johnson said. “That’s a travesty in my opinion.”

Each day’s programming will be anchored by a film screening and panel discussion, Lindsey said.

Saturday’s events will begin with “America’s Secret War,” a Twin Cities PBS documentary about the American military campaign into Laos during the Vietnam War and the Hmong troops who fought for the U.S. Minnesota is now home to the largest Hmong population in the country.

Sunday’s film will be another Twin Cities PBS documentary called “A Time to Heal,” which explores the service of women who worked as nurses during the Vietnam War.

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Lindsey said the experiences of Minnesota’s Southeast Asian immigrants offer lessons for the United States as the country welcomes refugees from more recent wars.

Gregor, who also served on the event’s advisory committee, said she hopes those who attend the commemoration will come away with a greater willingness to “give people grace and not judge people by the color of their skin.”

“We work hard,” she said of refugees. “We came with nothing. This is our country, this is our home now.”

By NICHOLAS RICCARDI, Associated Press

DENVER (AP) — After months of extraordinary steps to ensure his party maintains control of the U.S. House of Representatives in next year’s midterms, President Donald Trump is turning his sights toward the voting process in next week’s elections.

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That pivot is raising alarm among Democrats and others who warn that he may be testing strategies his administration could use to interfere with elections in 2026 and beyond.

Late last week, Trump’s Department of Justice announced it was sending election monitors to observe voting in one county in New Jersey, which features a race for governor that Trump has become deeply invested in, and to five counties in California, where Democratic Gov. Gavin Newsom is pushing a ballot measure to counter the president’s own effort to rejigger the congressional map to elect more Republicans.

That announcement was followed with a pre-emptive attack by Trump on the legitimacy of California’s elections. The post on his own social media platform echoed the baseless allegations he made about the 2020 presidential election before he and his allies tried to overturn his loss in a campaign that culminated in the Jan. 6, 2021, attack on the U.S. Capitol.

“Watch how totally dishonest the California Prop Vote is!” Trump wrote last weekend on Truth Social, referring to Proposition 50, the lone issue on the state’s special election ballot. “Millions of Ballots being ‘shipped.’”

The combination has prompted responses from several prominent Democrats, who were already bracing for Trump to use his presidential powers to tilt next year’s midterms to his side.

“It’s a bridge they’re trying to build the scaffolding for, all across this country, in next November’s elections,” Newsom said in a video in which he also predicted the administration will send masked immigration agents to polling stations next week.

During early voting so far, there has been no indication that troops or federal officers have shown up near polling sites or ballot drop boxes in any state. Despite the warnings from some Democrats, millions of voters already have cast ballots through early in-person or mail voting, a process that has produced no significant problems.

Voter Alex Colcho, from Norwalk, Calif., drops off his family’s ballots at a ballot box at the Los Angeles County Registrar-Recorder’s headquarters Wednesday, Oct. 29, 2025, in Norwalk, Calif. (AP Photo/Damian Dovarganes)

Voting expected to be ‘safe and secure’

Trump has long accused the Biden administration of trying to interfere in last year’s presidential election after the Justice Department filed federal charges against him related to his attempts to overturn the 2020 results and his retention of classified documents after leaving office.

White House spokeswoman Abigail Jackson, using the president’s favorite derogatory nickname for California’s governor, said in a statement on Wednesday: “Newscum ought to stop fearmongering to score political points with the radical left flank of the Democrat party that he is courting ahead of his doomed-to-fail presidential campaign.”

Tuesday’s elections are purely state-based, with no federal offices on the ballot. Trump has no ability to change the outcome in any way, experts said.

“Voters who go to vote in the 2025 election are going to find a very safe and secure process,” said David Becker, a former Department of Justice voting rights attorney who now runs the Center for Election Innovation & Research. “For example, I’m 100% confident that whoever wins the statewide elections in Virginia and New Jersey, regardless of what the president says, will take office.”

Some ballot questions have big implications for 2026

The relatively low-profile off-year elections are headlined by the races for governor in New Jersey and Virginia, California’s redistricting question and the mayor’s race in New York City.

Los Angeles County Election officials assist first time voter Robert Conejo, right, as he votes in person on California’s Proposition 50 election on Wednesday, Oct. 29, 2025, at the Los Angeles County Registrar-Recorder’s headquarters in Norwalk, Calif. (AP Photo/Damian Dovarganes)

Two of the states where voting already is underway are considering measures that have major implications for next year’s midterms.

In Pennsylvania, voters will decide whether three Democratic justices keep their seats on the state’s supreme court. If they’re removed, the court will have a 2-2 ideological split and potentially be unable to resolve disputes over voting and election procedures next year in the critical swing state.

In California, voters will decide whether to temporarily override an independent redistricting process and allow the Democratic-controlled Legislature to redraw the state’s congressional districts. If voters pass the measure, it could create five new seats Democrats could win to counter Trump’s push for Texas and other Republican-led states to redraw their districts and increase the number of winnable Republican House seats.

‘These are not normal times’

That’s one reason the administration’s decision to send monitors drew so much attention. It’s not unusual for the federal government to send monitors to observe voting and ballot counting in certain areas, but it’s typically done in consultation with local jurisdictions. That did not happen this time.

Instead, the Trump administration announced the monitors solely in response to requests from local Republican parties.

Federal monitors are only allowed to observe, are prohibited from talking to voters or even poll workers, and have no way to influence the counting of votes, said Becker, who has served as a monitor and also trained them.

“I don’t think voters are ever going to notice or see any of these people,” he said.

Still, the Democratic attorneys general in California and New Jersey raised alarms, with New Jersey’s Matt Platkin calling it “highly inappropriate” and California’s Rob Bonta saying the move is especially concerning given Trump’s record.

“These are not normal times,” Bonta said in a call with reporters this week. “We have to look at the broader context here about what the Trump administration is saying and what they are doing.”

The action follows a monthslong campaign by Trump to use the powers of his office to boost his party’s political prospects ahead of the midterms, where the incumbent party traditionally loses seats in Congress. The president has pushed states where Republicans control the redistricting process to redraw their boundaries to create more conservative-friendly seats. He also has directed his administration to investigate Democratic politicians, fundraisersand donors.

Is Trump positioning for the midterms?

Newsom and his Illinois counterpart, Gov. JB Pritzker, have warned that Trump’s attempts to send the U.S. military into their states’ most populous cities — Los Angeles and Chicago — are precursors to deploying the military or federal agents to polling places in Democratic-leaning cities next year.

FILE – California Gov. Gavin Newsom speaks during a news conference Aug. 14, 2025, in Los Angeles. (AP Photo/Marcio Jose Sanchez, File)

They and other Democrats also have alluded to how some Trump allies in 2020 used manufactured claims of election fraud to propose using the military to seize voting machines.

At the same time, the Justice Department is demanding detailed voter data from the states and Trump issued an executive order trying to reshape how elections are run, which has been largely halted by the courts because the Constitution gives that power to the states, and, in some cases, Congress. It spells out no role for the president in setting election rules.

Until fairly recently, Trump had been relatively quiet about the 2025 elections, mostly taking steps that other presidents have made in election years, such as supporting his party’s nominees in key races.

Hannah Fried, executive director of the voting rights group All Voting is Local, said the Nov. 4 election will provide “an important set of data points” about issues that could crop up in future elections, especially next year.

“That’s the big dog,” Fried said of the midterms. “Everybody in the country’s going to be voting in 2026. This is about control of Congress. As a country, we all have a stake in that.”