By Daniel Chang and Sam Whitehead, Kaiser Health News

MIAMI — GOP lawmakers in the 10 states that refused the Affordable Care Act’s Medicaid expansion for over a decade have argued their conservative approach to growing government programs would pay off in the long run.

Instead, the Republican-passed budget law that includes many of President Donald Trump’s priorities will pose at least as big a burden on patients and hospitals in the expansion holdout states as in the 40 states that have extended Medicaid coverage to more low-income adults, hospital executives and other officials warn.

For instance, Georgia, with a population of just over 11 million, will see as many people lose insurance coverage sold through ACA marketplaces as will California, with more than triple the population, according to estimates by KFF, a health information nonprofit that includes KFF Health News.

The new law imposes additional paperwork requirements on Obamacare enrollees, slashes the time they have each year to sign up, and cuts funding for navigators who help them shop for plans. Those changes, all of which will erode enrollment, are expected to have far more impact in states like Florida and Texas than in California because a higher proportion of residents in non-expansion states are enrolled in ACA plans.

The budget law, which Republicans called the “One Big Beautiful Bill,” will cause sweeping changes to health care across the country as it trims federal spending on Medicaid by more than $1 trillion over the next decade. The program covers more than 71 million people with low incomes and disabilities. Ten million people will lose coverage over the next decade due to the law, according to the nonpartisan Congressional Budget Office.

Many of its provisions are focused on the 40 states that expanded Medicaid under the ACA, which added millions more low-income adults to the rolls. But the consequences are not confined to those states. A proposal from conservatives to cut more generous federal payments for people added to Medicaid by the ACA expansion didn’t make it into the law.

“Politicians in non-expansion states should be furious about that,” said Michael Cannon, director of health policy studies at the Cato Institute, a libertarian think tank.

The number of people losing coverage could accelerate in non-expansion states if enhanced federal subsidies for Obamacare plans expire at the end of the year, driving up premiums as early as January and adding to the rolls of uninsured. KFF estimates as many as 2.2 million people could become uninsured just in Florida, a state where lawmakers refused to expand Medicaid and, partly as a result, now leads the nation in ACA enrollment.

For people like Francoise Cham of Miami, who has Obamacare coverage, the Republican policy changes could be life-altering.

Before she had insurance, the 62-year-old single mom said she would donate blood just to get her cholesterol checked. Once a year, she’d splurge for a wellness exam at Planned Parenthood. She expects to make about $28,000 this year and currently pays about $100 a month for an ACA plan to cover herself and her daughter, and even that strains her budget.

Cham choked up describing the “safety net” that health insurance has afforded her — and at the prospect of being unable to afford coverage if premiums spike at the end of the year.

“Obamacare has been my lifesaver,” she said.

If the enhanced ACA subsidies aren’t extended, “everyone will be hit hard,” said Cindy Mann, a health policy expert with Manatt Health, a consulting and legal firm, and a former deputy administrator for the Centers for Medicare & Medicaid Services.

“But a state that hasn’t expanded Medicaid will have marketplace people enrolling at lower income levels,” she said. “So, a greater share of residents are reliant on the marketplace.”

Though GOP lawmakers may try to cut Medicaid even more this year, for now the states that expanded Medicaid largely appear to have made a smart decision, while states that haven’t are facing similar financial pressures without any upside, said health policy experts and hospital industry observers.

Related Articles

Texas declares measles outbreak over

FDA’s new expert panels are rife with financial conflicts and fringe views

AI eroded doctors’ ability to spot cancer within months in study

This test can see a heart attack in your future

Serious Minnesota knitters wanted for project supporting breast cancer survivors

KFF Health News reached out to the governors of the 10 states that have not fully expanded Medicaid to see if the budget legislation made them regret that decision or made them more open to expansion. Spokespeople for Republican Gov. Henry McMaster of South Carolina and Republican Gov. Brian Kemp of Georgia did not indicate whether their states are considering Medicaid expansion.

Brandon Charochak, a spokesperson for McMaster’s office, said South Carolina’s Medicaid program focuses on “low-income children and families and disabled individuals,” adding, “The state’s Medicaid program does not anticipate a large impact on the agency’s Medicaid population.”

Enrollment in ACA marketplace plans nationwide has more than doubled since 2020 to 24.3 million. If enhanced subsidies expire, premiums for Obamacare coverage would rise by more than 75% on average, according to an analysis by KFF. Some insurers are already signaling they plan to charge more.

The CBO estimates that allowing enhanced subsidies to expire will increase the number of people without health insurance by 4.2 million by 2034, compared with a permanent extension. That would come on top of the coverage losses caused by Trump’s budget law.

“That is problematic and scary for us,” said Eric Boley, president of the Wyoming Hospital Association.

He said his state, which did not expand Medicaid, has a relatively small population and hasn’t been the most attractive for insurance providers — few companies currently offer plans on the ACA exchange — and he worried any increase in the uninsured rate would “collapse the insurance market.”

As the uninsured rate rises in non-expansion states and the budget law’s Medicaid cuts loom, lawmakers say state funds will not backfill the loss of federal dollars, including in states that have refused to expand Medicaid.

Those states got slightly favorable treatment under the law, but it’s not enough, said Grace Hoge, press secretary for Kansas Gov. Laura Kelly, a Democrat who favors Medicaid expansion but who has been rebuffed by GOP state legislators.

“Kansans’ ability to access affordable health care will be harmed,” Hoge said in an email. “Kansas, nor our rural hospitals, will not be able to make up for these cuts.”

For hospital leaders in other states that have refused full Medicaid expansion, the budget law poses another test by limiting financing arrangements states leveraged to make higher Medicaid payments to doctors and hospitals.

Beginning in 2028, the law will reduce those payments by 10 percentage points each year until they are closer to what Medicare pays.

Richard Roberson, president of the Mississippi Hospital Association, said the state’s use of what’s called directed payments in 2023 helped raise its Medicaid reimbursements to hospitals and other health institutions from $500 million a year to $1.5 billion a year. He said higher rates helped Mississippi’s rural hospitals stay open.

“That payment program has just been a lifeline,” Roberson said.

The budget law includes a $50 billion fund intended to insulate rural hospitals and clinics from its changes to Medicaid and the ACA. But a KFF analysis found it would offset only about one-third of the cuts to Medicaid in rural areas.

Trump encouraged Florida, Tennessee and Texas to continue refusing Medicaid expansion in his first term, when his administration gave them an unusual 10-year extension for financing programs known as uncompensated care pools, which generate billions of dollars to pay hospitals for treating the uninsured, said Allison Orris, director of Medicaid policy for the left-leaning think tank Center on Budget and Policy Priorities.

“Those were very clearly a decision from the first Trump administration to say, ‘You get a lot of money for an uncompensated care pool instead of expanding Medicaid,’” she said.

Those funds are not affected by Trump’s new tax-and-spending law. But they do not help patients the way insurance coverage would, Orris said. “This is paying hospitals, but it’s not giving people health care,” she said. “It’s not giving people prevention.”

States such as Florida, Georgia, and Mississippi have not only turned down the additional federal funding that Medicaid expansion brings, but most of the remaining non-expansion states spend less than the national average per Medicaid enrollee, provide fewer or less generous benefits, and cover fewer categories of low-income Americans.

Mary Mayhew, president of the Florida Hospital Association, said the state’s Medicaid program does not adequately cover children, older people and people with disabilities because reimbursement rates are too low.

“Children don’t have timely access to dentists,” she said. “Expectant moms don’t have access nearby to an OB-GYN. We’ve had labor and delivery units close in Florida.”

She said the law will cost states more in the long run.

“The health care outcomes for the individuals we serve will deteriorate,” Mayhew said. “That’s going to lead to higher cost, more spending, more dependency on the emergency department.”

(KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2025 Kaiser Health News. Visit khn.org. Distributed by Tribune Content Agency, LLC.

By TY ONEIL and CHRISTOPHER WEBER, Associated Press

LAS VEGAS (AP) — Tourism in Las Vegas is slumping this summer, with resorts and convention centers reporting fewer visitors compared to last year, especially from abroad, and some officials are blaming the Trump administration’s tariffs and immigration policies for the decline.

The city known for lavish shows, endless buffets and around-the-clock gambling welcomed just under 3.1 million tourists in June, an 11% drop compared to the same time in 2024. There were 13% fewer international travelers, and hotel occupancy fell by about 15%, according to data from the Las Vegas Convention and Visitors Authority.

People walk across a pedestrian bridge along the Las Vegas Strip, Friday, Aug. 8, 2025, in Las Vegas. (AP Photo/John Locher)

Mayor Shelley Berkley said tourism from Canada — Nevada’s largest international market — has dried up from a torrent “to a drip.” Same with Mexico.

“We have a number of very high rollers that come in from Mexico that aren’t so keen on coming in right now. And that seems to be the prevailing attitude internationally,” Berkley told reporters earlier this month.

Ted Pappageorge, head of the powerful Culinary Workers Union, called it the “Trump slump.” He said visits from Southern California, home to a large Latino population, were also drying up because people are afraid of the administration’s immigration crackdown.

“If you if you tell the rest of the world they’re not welcome, then they won’t come,” Pappageorge said.

Reflected in a glass window, people walk across a pedestrian bridge along the Las Vegas Strip, Friday, Aug. 8, 2025, in Las Vegas. (AP Photo/John Locher)

Canadian airline data shows fewer passengers from north of the border are arriving at Harry Reid International Airport in Las Vegas. Air Canada saw its passenger numbers fall by 33% in June compared to the same time a year ago, while WestJet had a 31% drop. The low-cost carrier Flair reported a whopping 62% decline.

Travel agents in Canada said there’s been a significant downturn in clients wanting to visit the U.S. overall, and Las Vegas in particular. Wendy Hart, who books trips from Windsor, Ontario, said the reason was “politics, for sure.” She speculated that it was a point of “national pride” that people were staying away from the U.S. after President Donald Trump said he wanted to make Canada the 51st state.

“The tariffs are a big thing too. They seem to be contributing to the rising cost of everything,” Hart said.

At downtown’s Circa Resort and Casino, international visits have dipped, especially from Canada and Japan, according to owner and CEO Derek Stevens. But the downturn comes after a post-COVID spike, Stevens said. And while hotel room bookings are slack, gaming numbers, especially for sports betting, are still strong, he said.

“It’s not as if the sky is falling,” he said. Wealthier visitors are still coming, he said, and Circa has introduced cheaper package deals to lure those with less money to spend.

“There have been many stories written about how the ‘end is near’ in Vegas,” he said. “But Vegas continues to reinvent itself as a destination worth visiting.”

On AAA’s annual top ten list of top Labor Day destinations, Las Vegas slipped this year to the last spot, from number six in 2024. Seattle and Orlando, Florida — home to Disneyworld — hold steady in the top two spots, with New York City moving up to third for 2025.

Reports of declining tourism were news to Alison Ferry, who arrived from Donegal, Ireland, to find big crowds at casinos and the Vegas Strip.

“It’s very busy. It has been busy everywhere that we’ve gone. And really, really hot,” Ferry said. She added that she doesn’t pay much attention to U.S. politics.

Just off the strip, there’s been no slowdown at the Pinball Museum, which showcases games from the 1930s through today. Manager Jim Arnold said the two-decade-old attraction is recession-proof because it’s one of the few places to offer free parking and free admission.

“We’ve decided that our plan is just to ignore inflation and pretend it doesn’t exist,” Arnold said. “So you still take a quarter out of your pocket and put it in a game, and you don’t pay a resort fee or a cancelation fee or any of that jazz.”

But Arnold said he’s not surprised that overall tourism might be slowing because of skyrocketing prices at high-end restaurants and resorts, which “squeezes out the low end tourist.”

The mayor said the rising cost of food, hotel rooms and attractions also keeps visitors away.

“People are feeling that they’re getting nickeled and dimed, and they’re not getting value for their dollar,” Berkley said. She called on business owners to “see if we can’t make it more affordable” for tourists.

“And that’s all we want. We want them to come and have good time, spend their money, go home,” the mayor said. “Then come back in six months.”

Weber reported from Los Angeles.

Taskrabbit is a popular side hustle option for handy go-getters, but it may feel daunting if you’re just starting out.

Kevin Johnson has been there, done that, and found success. He’s a college student based in Maryland and offers handyman and moving services on the side. His dream is to open an automotive repair shop one day, and he views this hustle as valuable, if nontraditional, career experience.

Finding a traditional job isn’t exactly easy these days. According to the most recent jobs report, the economy added just 73,000 jobs in July. Compare that with 275,000 new entrants — people seeking their first job — who joined the ranks of those already looking.

If you need or want work, take note of what established Taskers like Johnson do to succeed in the gig economy.

What the work is like

Taskrabbit connects customers with capable workers who can put together furniture, lift heavy objects, mount a TV, declutter a room, clean house, run errands and more. The workers — called Taskers on the app — work independently and flexibly.

“Being a Tasker helps with making your own schedule and setting your own rates,” said Johnson in an email interview.

Las Vegas-based Tasker Nola Rodgers likes the people side of the work, and the money. She started tasking in 2021, after graduating high school in 2020, and has turned it into a full-time living.

“I love being able to help families and businesses have what they need to operate daily,” she said in an email interview. “If you offer enough tasks in different categories, you could end up making livable money.”

Rodgers would know. She’s got ‘elite tasker’ status on her profile — which signifies experience and consistently high ratings.

How to stand out and succeed as a Tasker

Johnson and Rodgers have each completed well over 1,000 tasks. You can learn from their insight as you get started with Taskrabbit.

Specialize (in multiple high-demand skills)

Lean on your skills and into services that pay.

Rodgers does TV mounting, packing, organizing and unpacking and even minor home repairs, for example. She also builds a lot of Ikea stuff.

“Furniture assembly is what I get booked most often,” she said. She charges $41.29 per hour for furniture assembly and brings her own tools to the job.

Johnson gets a lot of moving and hauling jobs, which make use of the little red truck he bought in cash with his earnings.

He said “handyman work, such as furniture assembly and mounting [decor],” is good for pay and consistent bookings as well.

Optimize (your Taskrabbit profile)

Your profile is the front door of your Tasker business. Just starting out, you need a compelling pitch.

Rodgers’ profile is fun to read and conveys her passion for building things. Her service descriptions are clear and concise — only a couple lines of text — and include photos of past work (e.g., a big TV hanging level in a living room with all cables hidden).

Johnson, who does a lot of moving, mentions he has a truck, and provides a transparent breakdown of pricing on his profile.

Serve (customers with care)

When customers come knocking, treat them well. Responsiveness, timeliness and perfectionism are key qualities for successful Taskers.

Johnson said he responds to customer inquiries as quickly as he can and stays in contact throughout.

“I always arrive on time and keep them updated on my estimated arrival,” he said.

Customers and Taskers can chat and send photos about the job on the app and website, or connect on a call.

Rodgers also stressed the importance of doing right by the customer. “[It] builds word of mouth and helps with reviews and recommendations.”

Grind and grow (your Tasker earnings)

It may be wise to prioritize reviews over pay rates at first.

Rodgers was on the grind from day one, and said bookings came quickly. “I got on the app and I started doing same-day tasks — I started getting clients that day.” The same-day jobs gave way to advanced bookings, and the ability to earn more.

“I took pictures of my work as I finished tasks to start my portfolio and set my rates at what was recommended, and raised them as it was suggested by Taskrabbit,” she said.

The app offers pricing guidance based on location, task category and level of experience, so you can set competitive rates.

How much you can make depends on a range of factors, especially the time you have for hustling. Both Rodgers and Johnson estimated that new Taskers have the potential to earn around $1,000 – $1,500 a month, but that may not be realistic for all.

And don’t forget — you do gig work like Taskrabbit as a self-employed independent contractor, which means it’s on you to plan for tax time. The good news is Taskrabbit takes its service fee from clients — charged on top of the rate you set.

What to know before you gig

“It is still work,” said Rodgers. “You need to be committed and hardworking.”

Being bossless sounds cool, but without one you’ll have to get out of bed and get going on your own.

Passion helps, Johnson said. “Whatever skill resonates with you, give it your absolute best.”

Reddit reviews are mixed

We sifted through Reddit forums to get a pulse check on how users feel about Taskrabbit as a viable side hustle. Taskrabbit isn’t all roses for everyone who’s tried it. A quick review may dash your spirits. We used an AI tool to help analyze the feedback. People post anonymously, so we cannot confirm their individual experiences or circumstances.

These potential negatives stood out.

Market saturation: Big cities may have many Taskers competing for work, which makes it tough to get regular gigs.
Inconsistent income: Since gigs can be sporadic, working as a Tasker won’t guarantee the consistent income of a salaried or hourly job.
Need for multiple skills: Taskers tend to need skills in various types of task areas to maximize earning potential (e.g., handyman and hauling).

A bridge to what’s next

While your level of success will vary, what you learn as a Tasker could lead to something more.

Around 1 in 13 Americans (7%) set a goal to start a business in 2025, according to a recent NerdWallet study.

As a Tasker, Johnson emphasizes treating customers well, showing up on time, looking the part and doing the job well, qualities that will serve him if his auto shop comes to fruition.

Rodgers aspires to more too. “Over the next five years, I plan to expand my business by making custom furniture,” she said.

She credits the hustle of gig work for helping her launch a business, earn a meaningful wage and build a base of clients.

More From NerdWallet

Big Paychecks, Big Regrets: How to Avoid Splurge Pitfalls
What Does It Mean to Be Rich? We Asked 3 People.
Four Frequent Money Worries – And What To Do About Them

Tommy Tindall writes for NerdWallet. Email: ttindall@nerdwallet.com.

The article Taskrabbit Work: What It’s Like and How to Succeed originally appeared on NerdWallet.

By BILL BARROW, TRAN NGUYEN, FERNANDA FIGUEROA and JOHN HANNA, Associated Press

AUSTIN, Texas (AP) — Texas Democrats who ended a walkout found themselves shadowed by law enforcement officers to keep them from repeating the protest that stalled Republican efforts to redraw congressional districts and fulfill President Donald Trump’s desire to reshape U.S. House maps.

Republicans in the Texas House forced returning Democrats to sign what the Democrats called “permission slips,” agreeing to around-the-clock surveillance by state Department of Public Safety officers to leave the floor. However, Democratic Rep. Nicole Collier, of Fort Worth, refused and remained on the House floor Monday night.

Texas Troopers gather in the gallery of the House Chamber at the Texas Capitol after a second special session was gaveled in, Monday, Aug. 18, 2025, in Austin, Texas. (AP Photo/Eric Gay)

The Democrats’ return to Texas puts the Republican-run Legislature in position to satisfy Trump’s demands, possibly later this week, as California Democrats advance new congressional boundaries in retaliation.

Lawmakers had officers posted outside their Capitol offices, and suburban Dallas Rep. Mihaela Plesa said one tailed her on her Monday evening drive back to her apartment in Austin after spending much of the day on a couch in her office. She said he went with her for a staff lunch and even down the hallway with her for restroom breaks.

“We were kind of laughing about it, to be honest, but this is really serious stuff,” Plesa said in a telephone interview. “This is a waste of taxpayer dollars and really performative theater.”

Collier, who represents a minority-majority district, said she would not “sign away my dignity” and allow Republicans to “control my movements and monitor me.”

“I know these maps will harm my constituents,” she said in a statement. “I won’t just go along quietly with their intimidation or their discrimination.”

2 states at the center of an expanding fight

The tit-for-tat puts the nation’s two most populous states at the center of an expanding fight over control of Congress ahead of the 2026 midterm elections. The battle has rallied Democrats nationally following infighting and frustrations among the party’s voters since Republicans took total control of the federal government in January.

Related Articles

Gabbard says UK scraps demand for Apple to give backdoor access to data

Appeals court overturns order that stripped some protections from pregnant Texas state workers

Maine police officer arrested by ICE agrees to voluntarily leave the country

Judge issues injunction preventing Trump’s FTC from investigating watchdog Media Matters

Trump vows to change how elections are run. The US Constitution doesn’t give him that power

Dozens of Texas Democratic lawmakers left for Illinois and elsewhere on Aug. 3, denying their Republican colleagues the attendance necessary to vote on redrawn maps intended to send five more Texas Republicans to Washington. Republicans now hold 25 of Texas’ 38 U.S. House seats.

They declared victory Friday, pointing to California’s proposal intended to increase Democrats’ U.S. House advantage by five seats. Many absent Democrats left Chicago early Monday and landed hours later at a private airfield in Austin, where several boarded a charter bus to the Capitol. Cheering supporters greeted them inside.

Republican House Speaker Dustin Burrows did not mention redistricting on the floor but promised swift action on the Legislature’s agenda.

“We aren’t playing around,” Republican state Rep. Matt Shaheen, whose district includes part of the Dallas area, said in a post on the X social media platform.

Democrats promise to keep fighting

Even as they declared victory, Democrats acknowledged Republicans can now approve redrawn districts. Texas House Minority Leader Gene Wu said Democrats would challenge the new designs in court.

Texas Democratic lawmakers return to Texas after leaving two weeks ago to block a vote on a redrawn redistricting map, Monday, Aug. 18, 2025, in Austin, Texas. (AP Photo/Eric Gay)

Lawmakers did not take up any bills Monday and were not scheduled to return until Wednesday.

Trump has pressured other Republican-run states to consider redistricting, as well, while Democratic governors in multiple statehouses have indicated they would follow California’s lead in response. Democratic California Gov. Gavin Newsom has said his state will hold a Nov. 4 special referendum on the redrawn districts.

The president wants to shore up Republicans’ narrow House majority and avoid a repeat of the midterms during his first presidency. After gaining House control in 2018, Democrats used their majority to stymie his agenda and twice impeach him.

Nationally, the partisan makeup of existing district lines puts Democrats within three seats of a majority. Of the 435 total House seats, only several dozen districts are competitive. So even slight changes in a few states could affect which party wins control.

Redistricting typically occurs once at the beginning of each decade after the census. Many states, including Texas, give legislators the power to draw maps. California is among those that empower independent commissions, giving Newsom an additional hurdle.

California Democrats start redrawing process

Democratic legislators introduced new California maps Monday. It was the first official move toward the fall referendum asking voters to override the independent commission’s work after the 2020 census. The proposed boundaries would replace current ones through 2030. Democrats said they will return the mapmaking power to the commission after that.

California Assembly Speaker Robert Rivas announces a legislative package to advance a partisan effort to redraw California congressional map at a press conference on Monday, Aug. 18, 2025, in Sacramento, Calif. (AP Photo/Tran Nguyen)

State Republicans promised lawsuits.

Democrats hold 43 out of California’s 52 U.S. House seats. The proposal would try to expand that advantage by targeting battleground districts in Northern California, San Diego and Orange counties, and the Central Valley. Some Democratic incumbents also get more left-leaning voters in their districts.

“We don’t want this fight, but with our democracy on the line, we cannot run away from this fight,” said Democrat Marc Berman, a California Assembly member who previously chaired the elections committee.

Republicans expressed opposition in terms that echoed Democrats in Austin, accusing the majority of abusing power. Sacramento Republicans said they will introduce legislation advocating independent redistricting commissions in all states.

Texas’ governor jumped to the president’s aid

Texas Republican Gov. Greg Abbott launched the expanding battle when he heeded Trump’s wishes and added redistricting to an initial special session agenda that included multiple issues, including a package responding to devastating floods that killed more than 130 people last month.

Abbott has blamed Democrats’ absence for delaying action on those measures. Democrats have answered that Abbott is responsible because he effectively linked the hyper-partisan matter to nonpartisan flood relief.

Abbott, Burrows and other Republicans tried various threats and legal maneuvers to pressure Democrats’ return, including the governor arguing that Texas judges should remove absent lawmakers from office.

As long as they were out of state, lawmakers were beyond the reach of the civil arrest warrants that Burrows issued. The Democrats who returned Monday did so without being detained by law enforcement.

The lawmakers who left face fines of up to $500 for each legislative day they missed. Burrows has insisted Democratic lawmakers also will pay pick up the tab for law enforcement who attempted to corral them during the walkout.

Barrow reported from Atlanta. Nguyen reported from Sacramento, California. Hanna reported from Topeka, Kansas.