Her husband was deported to Mexico. Unwilling to remain apart, she left the US to join him.

posted in: All news | 0

As the vehicle approached the Tijuana border, Etelvina Lázaro’s son, sitting behind the wheel, asked her again if she was sure.

“I’ve already made up my mind,” she recalled telling him in Spanish. “I’m leaving.”

Lázaro, a 54-year-old grandmother, had lived with her family in San Diego for over 20 years. But after her husband, Margarito, was arrested by federal immigration agents in mid-July and then deported, she made the hard decision to leave her grown children and grandchildren behind and follow him to Mexico.

She is one of several undocumented immigrants who have decided to leave the country on their own amid President Donald Trump’s intensified efforts to crack down on illegal immigration.

The federal government launched a process in May dubbed Project Homecoming, urging undocumented immigrants to return to their native countries or face the consequences. Through the CBP Home mobile app, eligible individuals can register for voluntary departure and receive a $1,000 exit bonus, a flight home and an exemption from fines for failure to depart.

“Leave on your own terms. Avoid the jail cell. Avoid the humiliation,” reads an Immigration and Customs Enforcement post about “self-deportation” on the social media platform X.

A Department of Homeland Security spokesperson said Thursday that “tens of thousands” of undocumented immigrants have utilized the CBP Home app but didn’t provide a specific number.

Data obtained by ProPublica from DHS indicates that there have been about 25,000 departures via the mobile app — and a little more than half of them returned with assistance from the federal agency, according to the news report.

But it’s unclear how many, like Lázaro, have left quietly.

Etelvina Lázaro in her apartment for the last time on Oct. 2 in San Diego. (Ana Ramirez / The San Diego Union-Tribune)

Lázaro said she was unaware of such a process. Instead, she chose to leave on her own. In a way, she said, she is still hurt by what happened. Earlier this month, she had her son drive her to Tijuana, and from there, she flew to her hometown in Michoacán.

She left because she wanted to be with her husband, rather than out of fear of being detained. She said that fear went away when they were separated.

María Chávez, a San Diego-based immigration attorney, said two of her clients opted to self-deport after being detained outside the courthouse.

People have also been asking Chávez or other attorneys about the CBP Home app and whether those who have used it are actually receiving the $1,000.

“For the individuals who are detained, it’s because they don’t want to be detained. They’re not criminals. They’ve never done anything bad or anything that would warrant them to be detained,” she said.

In the other cases she has heard about, she said, “it’s more so about just being afraid of being caught and wanting to leave with their dignity intact,” she said. “They want to be the ones to dictate how and when.”

Also, she said, “There are people who are just leaving on their own and not even bothering to go through the app.”

Similar efforts have been made by previous administrations. In 2008, the federal government introduced a “Scheduled Departure” pilot program in some U.S. cities, including San Diego. The program ultimately ended after failing to generate interest.

The opportunity to say goodbye

Two days before Lázaro left, her church group at the Our Lady of Guadalupe parish in Logan Heights, where she and her husband were once sacristans, took a moment at the end of a meeting to hug her and say heartfelt goodbyes. It was something they never had the chance to do with her husband.

Etelvina Lázaro, right, hugs a fellow parishioner goodbye. (Ana Ramirez / The San Diego Union-Tribune)

Lázaro sat with her head bowed in the middle of the room while those around her put their hands on her shoulders and wished her well one last time.

“May she know that no matter where they are in the world, they will always be part of our community,” wished one of the parishioners. “May they never feel alone.”

“It’s sad to see someone who has been forced to leave,” said Deacon Javier Mozo, who has known the family for years. “But at the same time, there is also joy because she is a woman willing to follow her husband wherever he goes. That speaks to the love between them … humans may try to divide them, but God will bring them back together in any situation.”

The night after, at her San Diego apartment, she managed to fit part of the life she had built in the U.S. over the years into three suitcases and two large bags.

Etelvina Lázaro in an almost empty apartment with 20 years of packed belongings in several suitcases on Oct. 2. (Ana Ramirez / The San Diego Union-Tribune)

She glanced around one more time. The family photos that had once adorned the walls were now in one of the bags, frameless. Among them was a photo of her and her husband on their wedding day. She also packed two hats that her husband did not have a chance to take with him.

“It was very hard to make this decision,” she said, fighting back tears. “It hurts me because of my children. It hurts that we are going to be separated.”

Their lives changed the moment she received a call from her husband letting her know that he had been arrested by federal agents while on his way to his construction job. Her husband, who had previously been deported in 2008, agreed not to fight his case and to be sent back to Mexico.

Etelvina Lázaro rests her hand on a passport. (Ana Ramirez / The San Diego Union-Tribune)

Lázaro, who cleaned houses for a living, said that it didn’t take long for her husband’s absence to take a toll on her.

“I’m not the same person I used to be,” she said. “Sometimes I just want to go to bed and sleep. I don’t feel like doing anything.”

Her children encouraged her to go to Mexico to be with their father, assuring her that they would take care of each other.

“It’s sad. It won’t be the same anymore,” said her eldest son, José Peña. “I won’t be able to stop by and see my mom every day.”

At the same time, Peña said he believes it’s time for her to rest and spend time with their father.

Lázaro said that she and her husband plan to eventually move to Tijuana so that their children can visit them. Her husband plans to get back to work in construction.

Father Scott Santarosa of Our Lady of Guadalupe parish blesses a group on Oct. 1. (Ana Ramirez / The San Diego Union-Tribune)

The Rev. Scott Santarosa of Our Lady of Guadalupe said that the farewell gathering was intended to provide closure, which is something that not many immigrant families have the opportunity to experience.

“He disappeared,” he said of Lázaro’s husband. “We couldn’t say goodbye, and it left a huge hole in our people and in our community.”

Rebuilding a life together

Lázaro reunited with her husband in the rural town of San Francisco Uricho, Michoacán. They are staying with her mother, whom she had not seen in decades.

Etelvina Lázaro and her husband Margarito on their wedding day. (Ana Ramirez / The San Diego Union-Tribune)

In a phone interview last week, she said that the town of more than 2,000 inhabitants has changed a lot since she and her husband left in search of a better life. There are more houses and people. Still, she said, many like her migrated to the U.S. over the years.

She acknowledged the sadness she felt the night she crossed the border back into Mexico after being away for many years.

A week later, after having had time to process things, she says she feels she can, at least for now, adapt to living in her old town again.

Suicide claims more Gen Z lives than previous generation

posted in: All news | 0

By Tim Henderson, Stateline.org

Editor’s note: If you or someone you know needs help, the national suicide and crisis lifeline in the U.S. is available by calling or texting 988. There is also an online chat at 988lifeline.org.

For Gen Z adults, the oldest of whom are now reaching their late 20s, suicide is taking more lives than 10 years ago when millennials were the same age, according to a Stateline analysis of federal death statistics.

Related Articles


Losing a family pet gives parents a chance to teach children about death and grieving


Losing a family pet gives parents a chance to teach children about death and grieving


Workers’ wages siphoned to pay medical bills, despite consumer protections


Q&A: Sue Abderholden on a career spent reshaping Minnesota mental health services


Nuclear missile workers are contracting cancer. They blame the bases

The bulk of the increase, 85%, is among Black and Hispanic men, many in Southern and Midwestern states.

Experts disagree on the root causes of the growth in suicides, but they see a wave of untreated depression that can lead to suicidal thoughts, one that affected all age groups after the Great Recession but lingers on among young adults, especially non-white men.

Theories behind the increase range from bullying on social media, since Gen Z was the first generation to grow up with the internet, to economic despair, to cultural resistance to seeking help for depression.

Gen Z suicides have continued at a fast pace this year, with 1,148 in January and February, the latest months available from the federal Centers for Disease Control and Prevention, about the same as in 2024. The CDC bases its data on death certificates.

Among those grappling with the crisis is Rodney Harris of the University of North Carolina School of Medicine, who has enlisted barbers and churches in his state to draw out stories of personal pain before they lead to a suicidal crisis. Harris is an associate professor in the school’s Suicide Prevention Institute.

He’s fighting a perception that you can shake off mental health issues on your own.

“The research tells us that we have got to find a live person to go to them, particularly Black and brown kids, because if we don’t, they’ll get lost,” said Harris. “There’s a perception that you’re going to be strong and not complain about things, and that can keep you away from treatment.”

Some visible signs of the crisis have shaken communities in recent weeks.

A bridge in majority-Hispanic Taos County, New Mexico, closed to pedestrians in September after a rash of suicides, including that of a teenager less than two weeks ago.

Also in September: A Black 21-year-old student hanged himself from a tree on a Mississippi university campus, authorities said, in a case that raised fears of lynching before his death was ruled a suicide.

For Julian “Wolf” Rivera, who died at 27 in 2019 in suburban Middletown, New York, there was a combination of issues, his mother said: pressure to support a growing family with a second child on the way, a night job in a warehouse that he found unfulfilling, discrimination he felt because of his Hispanic background despite being born and raised nearby by parents with a Puerto Rican heritage.

Rivera also struggled to accept and then to find help for his mental health issues, said his mother, Jessie Edmond.

“He was diagnosed with depression. He used to get angry. ‘Why? Why do I need medicine to be normal?’” Edmond said. “He would take medicine, go to therapy, feel better and say, ‘I don’t need medicine anymore.’ When he was in crisis he finally reached out, but nobody was taking patients. No one called him back.”

Like many states, New York is facing the unexpected loss of millions of dollars for mental health programs as part of cutbacks by the Trump administration’s Department of Government Efficiency task force. Federal grants for mental health crisis teams and drug treatment were cut by $88 million in April, and more cuts are feared as President Donald Trump’s One Big Beautiful Bill Act takes effect.

Among other things, the federal government in July ended an LGBTQ+-specific suicide helpline for people under 25.

A growing awareness of the suicide problem among young people led to federal responses, including a 2019 Congressional Black Caucus report on suicide among young Black people. But some of those programs are facing setbacks under the new Trump administration, and they could disappear or be forced to rely more on already stressed state funding.

More despair

Suicides increased among Asian, Black, Hispanic and Native young adults, according to the Stateline analysis, with Native people having the highest rate in both 2014 and 2024. The number of suicides dropped slightly for white people, but increased as a rate because population fell as Gen Z took over the age bracket from the more numerous millennial generation.

Suicide became the second-highest cause of death for young Hispanics, surpassing homicide, and became the No. 1 cause of death for young Asians, surpassing accidents. Men have the highest rates, especially Black and Hispanic men, who together account for 85% of the total increase in suicide, 822 of 965.

Young white adults had a higher suicide rate in 2014 than Black or African American people, but by 2024 the rate for young Black adults was higher. Men have the highest suicide rates but the rate for women is growing faster, from about one-fifth of the rate for men to one-fourth in 2024.

The largest increases in suicide rates for the age group were in Georgia (up 65%), North Carolina and Texas (up 41%), Alabama (up 39%) and Ohio (up 37%).

The highest rate is in Alaska, which was also highest in 2014, up 34% to a rate of 49 suicides per 100,000 population, followed by New Mexico and Montana. The lowest rate was in New Jersey, with a rate of 6.9, a decrease of 31% since 2014, when it was ranked No. 47 behind California, New York and Massachusetts.

Harris’ work in North Carolina was part of the federal Black Youth Suicide Prevention Initiative, under the Substance Abuse and Mental Health Services Administration. The state, along with others, also used a one-year federal grant to enhance access to mental health services for young people.

North Carolina’s health department has pledged to continue the work, Harris said. The state “remains committed to providing resources to communities which have been marginalized and where mental health challenges persist,” a state health department spokesperson, James Werner, told Stateline in a statement.

The federal initiative was formed to reduce suicides among Black young people and children, with 15 states and the District of Columbia chosen to make state-specific policy plans: Georgia, Illinois, Indiana, Kentucky, Louisiana, Maryland, Michigan, Minnesota, Mississippi, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania and Tennessee.

North Carolina and Minnesota have released action plans based on the program. And other states have also taken action: Louisiana created promotional campaigns to reach young people at a rivalry college football game, and Oregon developed a youth-led suicide prevention coalition with matching funds from the state health department.

Georgia stands out for the biggest change in youth suicides; they rose 70% to 311 deaths in 2024. The state used two federal programs, the youth suicide prevention initiative and one from the U.S. Office of Minority Health to the medical school at Morehouse School of Medicine, to look for policy solutions to high suicide rates.

A report from the medical school outlining policy recommendations is nearing completion, said Susan McLaren, an assistant project director with the Georgia Health Policy Center at Georgia State University, which is evaluating the ideas.

The medical school is embracing the concept of “nothing about us without us” that brings in young people to lead decision-making about suicide prevention policies, McLaren said.

“The current crisis among our Black youth is a result of many things: stigma, lack of resources and treatment, and insufficient focus on creating safe spaces and dialogue to prevent and intervene in mental health challenges,” McLaren said.

McLaren declined comment on funding issues, but the staff at the Office of Minority Health, which provided the Morehouse grant, has reportedly been slashed in a Trump administration reorganization.

Another federal program at SAMHSA, the Garrett Lee Smith State/Tribal Youth Suicide Prevention and Early Intervention Program, gives grants of up to $735,000 to states and tribes to fight youth suicide. The program is named for the son of Republican U.S. Sen. Gordon Smith of Oregon. The younger Smith died the day before his 22nd birthday in 2004.

‘No one magic answer’

The overall crisis in suicide among youth has long puzzled researchers, but it’s associated with an increase in untreated depression, said Dave Marcotte, a professor at American University in Washington, D.C., who wrote about the crisis in 2023 for the National Bureau of Economic Research.

Suicide rates for all age groups fell for decades before rising again starting in 2000, Marcotte said, and getting worse in the Great Recession. Rates for middle-aged people fell back again, but for young people the crisis never abated, he said.

“There’s likely no one magic answer to this,” Marcotte said. “Future job prospects for this generation are not what they were for older generations. Today’s generation is not guaranteed a position in society that’s better than their parents. That’s one hypothesis.”

Today’s generation is not guaranteed a position in society that’s better than their parents. — Dave Marcotte, American University professor

Another theory: Those born after 1995, including Gen Z adults, are the first to spend their entire adolescence with smartphones and social media. Substituting in-person socializing with bullying-prone online chatting is a prime cause of young depression, said Jean Twenge, a psychology professor at San Diego State University, who wrote an influential 2017 article in The Atlantic with the headline “Have Smartphones Destroyed a Generation?”

Heavy users of social media are more likely to be depressed, Twenge told Stateline, even among marginalized groups. And politics seems to play little part, she argues. In a post this May, Twenge noted that increases in Black and Hispanic depression began in 2012, as President Barack Obama was about to be elected to a second term, and well before Donald Trump was elected for the first time.

That same year, though, saw virulently racist memes and hate speech become increasingly widespread on Facebook and Twitter as Obama ran for reelection.

Researcher Jonathan Haidt added another reason why today’s youth might face more mental health challenges: When they were children, parents became more leery of letting them play unsupervised as fears of kidnapping and abuse increased. So they spent less time learning to interact face-to-face and more time in an adult online world they weren’t prepared to handle.

“These two trends — overprotection in the real world and underprotection in the virtual world — are the major reasons why children born after 1995 became the anxious generation,” wrote Haidt, a professor at New York University, in his 2024 book “The Anxious Generation.”

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

1.4M lawfully present immigrants could lose subsidized health coverage

posted in: All news | 0

By Shalina Chatlani, Stateline.org

An estimated 1.4 million immigrants who are in the country legally but are not citizens stand to lose their government-subsidized health care coverage under the sweeping tax and spending bill President Donald Trump signed into law this summer, according to estimates from the nonpartisan Congressional Budget Office.

Related Articles


Her husband was deported to Mexico. Unwilling to remain apart, she left the US to join him.


Government shutdown could be the longest ever, Speaker Johnson warns


In the fire zones, an immigrant workforce warily carries out cleanups


Some Indigenous Peoples Day events strike conciliatory tone amid Trump’s focus on Columbus


‘This shutdown feels different.’ Some worry states might not get repaid when government reopens

The One Big Beautiful Bill Act cuts federal spending on Medicaid, the joint federal-state health insurance program for low-income people. It also places new eligibility restrictions on lawfully present immigrants, including refugees and asylees, who are enrolled in a variety of government-subsidized health programs: Medicaid, the Children’s Health Insurance Program (CHIP), Medicare and Affordable Care Act marketplaces.

Immigrants who are in the country illegally have long been ineligible for federally funded health coverage.

But seven states — California, Colorado, Illinois, Minnesota, New York, Oregon and Washington — plus the District of Columbia have extended state-funded coverage to some income-eligible noncitizen adults regardless of their immigration status. Fourteen states plus the district provide state-funded coverage to noncitizen children whether they are here legally or not.

The new restrictions in the One Big Beautiful Bill Act, combined with other Trump policies limiting public benefits for immigrants, put those states in a financial bind. With less federal money to provide health benefits to immigrants who are here legally, states will be hard-pressed to maintain their programs that offer coverage to all immigrants, regardless of their legal status.

“We’re taking a giant step backwards from that public health and preventive health measure by excluding more people and draining federal resources from states that need it,” said Tanya Broder, a senior counsel specializing in immigrant health policy at the National Immigration Law Center, an advocacy group.

“And the result will be that our health — individually, as families and as communities — will be in jeopardy, and the health care infrastructure that serves all of us will also be compromised,” Broder said.

Already, some states that had offered health coverage aid to all immigrants — regardless of status — have been pulling back.

To help close a $12 billion deficit, California Democratic Gov. Gavin Newsom in June signed a state budget that bars immigrants who are here illegally from enrolling in the state’s Medicaid program, known as Medi-Cal. Current enrollees between the ages of 19 and 59 will have to pay a new $30 monthly premium beginning in 2027. In July 2026, the state will eliminate dental care for noncitizens.

Illinois in July ended its state-funded health coverage program for all immigrants ages 42 to 64. The state still operates a state-funded plan for residents 65 and older regardless of immigration status, but enrollment has been paused. And Minnesota also plans to exclude adult immigrants who are here illegally from a program that used to provide coverage regardless of immigration status.

New York is in an especially tough spot, since its state constitution prohibits discrimination against lawfully present immigrants in providing public benefits.

“States have had some type of leeway to fund resources for migrant communities if they want to,” said Medha Makhlouf, a law professor and the founding director of the Medical-Legal Partnership Clinic at Penn State Dickinson Law who studies immigrants’ access to health care. “But now this [federal] law makes it difficult for them to do that.”

Making it less attractive to stay

Jessica Vaughan, director of policy studies at the Center for Immigration Studies, a nonprofit group that backs stricter immigration policies, said these efforts are part of both Trump’s larger anti-immigration stance and “Congress’ interest in getting rid of any incentive or benefit for people who are in the country illegally.”

“It’s a way of making it less attractive for people to stay here illegally, right?” Vaughan said. “They’re trying to give people reasons to leave rather than reasons to stay.”

As noncitizens who are here legally lose access to federally funded benefits, the demand for state-funded coverage is “likely to increase,” Drishti Pillai, director of immigrant health policy at KFF, a health policy research group, told Stateline.

“However, at the same time, states are facing increasing budget pressures, especially with the Medicaid cuts,” Pillai said. “So it’s almost a double whammy, where there will likely be increased demand for state-funded coverage programs, but also states will have fewer resources to cover people.”

Makhlouf said the Trump administration’s policy changes reflect a broader strategy of stripping public benefits from marginalized and poor communities.

“Everyone who cares about access to health care needs to pay attention to what’s happening to immigrants,” she said. “When it becomes normalized to be able to sacrifice certain people’s humanity or their vulnerability, or to minimize their contributions to society, and say, ‘You don’t deserve access to health care,’ then that can be turned on to any group.”

Under Trump’s domestic policy law, California expects to lose at least $28.4 billion in federal Medicaid funding, according to Newsom’s office.

On the California Senate floor June 27, Democratic state Sen. María Elena Durazo expressed her sorrow at the state’s decision to deny coverage to immigrants.

“I can’t express how much joy I felt when we expanded basic health care,” Durazo said. “Today, that joy that I was so happy about, that joy has turned into pain, that joy has turned into shame.”

Democratic Senate Pro Tem Mike McGuire, however, said the state had little choice.

“We are a state of immigrants, 10.6 million strong. And we will never turn our backs on those who are part of the heart of the largest economy in the United States of America,” McGuire said during the debate. “So we’ve had to make some tough decisions. I know we’re not going to please everyone.”

Obligated in New York

One state, New York, is particularly in a bind, because its constitution requires it to provide coverage to lawfully present noncitizens.

Roxana, 27, has been living in the U.S. under the Deferred Action for Childhood Arrivals program, known as DACA, since she was 8 years old and is using her first name only out of fear she will be targeted. At the end of 2019, she experienced a range of debilitating symptoms, including pelvic pain and chronic fatigue, and discovered a noncancerous lump on her breast.

“Chronic illness has impacted my career trajectory with a lot of fatigue and chronic pain,” said Roxana, who lives in the Bronx, New York.

Roxana cannot get federally funded Medicaid. But she qualified for state-funded public health coverage in New York. A 2001 court case, Aliessa v. Novello, requires the state to offer publicly funded health coverage to all lawfully present residents under the state constitution. So, she could afford to go to the doctor, where she learned that she had a hormonal condition called polycystic ovary syndrome, or PCOS, and she was able to get the lump removed.

New York mostly picked up the tab for immigrants and other lawfully residing immigrants until 2016, when it launched coverage it called the Essential Plan under the 2010 Affordable Care Act, also known as Obamacare. Under the ACA, the plan has no deductibles or monthly premiums for patients, and the federal government has picked up almost the entire cost — 90% — of the plan, a huge economic relief for the state.

Now, New York faces an annual loss of $13.5 billion in federal Medicaid and Affordable Care Act funds. Additionally, the phasing out of premium tax credits for noncitizens under Trump’s law would lead to a loss of $7.5 billion in annual funding to the state’s Essential Plan, which covers 1.7 million New Yorkers.

“These are billions of dollars that are being taken away and out of New York’s delivery system,” Amir Bassiri, director of Medicaid at the New York State Department of Health, said at a United Hospital Fund conference on July 30.

It’s unclear whether and how the state will afford to cover people like Roxana, even though it’s required under the state’s constitution. Like other immigrants, she is terrified that in the face of cuts and shrinking safety net access for noncitizens, she will lose continuous health care coverage and that her condition will get worse.

“My PCOS symptoms have just been getting worse over the years. I really want to try my best with the health access that I have to get it under control.”

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

Government shutdown could be the longest ever, Speaker Johnson warns

posted in: All news | 0

By LISA MASCARO, AP Congressional Correspondent

WASHINGTON (AP) — Republican Speaker Mike Johnson predicted Monday the federal government shutdown may become the longest in history, saying he “won’t negotiate” with Democrats until they hit pause on their health care demands and reopen.

Related Articles


Some Indigenous Peoples Day events strike conciliatory tone amid Trump’s focus on Columbus


‘This shutdown feels different.’ Some worry states might not get repaid when government reopens


Education Department layoffs hit offices that oversee special education and civil rights enforcement


China’s exports to US drop in September, while rise in global shipments hits a 6-month high


China shows no sign of backing down while issuing call for US to withdraw tariff threat

Standing alone at the Capitol on the 13th day of the shutdown, the speaker said he was unaware of the details of the thousands of federal workers being fired by the Trump administration. It’s a highly unusual mass layoff widely seen as way to seize on the shutdown to reduce the scope of government. Vice President JD Vance has warned of “painful” cuts ahead, even as employee unions sue.

“We’re barreling toward one of the longest shutdowns in American history,” Johnson of Louisiana said.

With no endgame in sight, the shutdown is expected to roll on for the unforeseeable future. The closure has halted routine government operations, shuttered Smithsonian museums and other landmark cultural institutions and left airports scrambling with flight disruptions, all injecting more uncertainty into an already precarious economy.

The House is out of legislative session, with Johnson refusing to recall lawmakers back to Washington, while the Senate, closed Monday for the federal holiday, will return to work Tuesday. But senators are stuck in a cul-de-sac of failed votes as Democrats refuse to relent on their health care demands.

Johnson thanked President Donald Trump for ensuring military personnel are paid this week, which removed one main pressure point that may have pushed the parties to the negotiating table.

At its core, the shutdown is a debate over health care policy — and particularly the Affordable Care Act subsidies that are expiring for millions of Americans who rely on government aid to purchase their own health insurance policies on the Obamacare exchanges. Democrats demand the subsidies be extended, Republicans argue the issue can be dealt with later.

With Congress and the White House stalemated, some are eyeing the end of the month as the next potential deadline to reopen government.

That’s when open enrollment begins, Nov. 1, for the health program at issue, and Americans will face the prospect of skyrocketing insurance premiums. The Kaiser Family Foundation has estimated that monthly costs would double if Congress fails to renew the subsidy payments that expire Dec. 31.

It’s also when government workers on monthly pay schedules, including thousands of House aides, will go without paychecks.

The health care debate has dogged Congress ever since the Affordable Care Act became law under then-President Barak Obama in 2010.

The country went through a 16-day government shutdown during the Obama presidency when Republicans tried to repeal the Affordable Care Act 2013.

Trump tried to “repeal and replace” the law, commonly known as Obamacare, during his first term, in 2017, with a Republican majority in the House and Senate. That effort failed when then-Sen. John McCain memorably voted a thumbs down on the plan.

With 24 million now enrolled in Obamacare, a record, Johnson said Monday that Republicans are unlikely to go that route again, noting he still has “PTSD” from that botched moment.

“Can we completely repeal and replace Obamacare? Many of us are skeptical about that now because the roots are so deep,” Johnson said.

The Republican speaker insists his party has been willing to discuss the health care issue with Democrats this fall, before the subsidies expire at the end of the year. But first, he said, Democrats have to agree to reopen the government.

The longest shutdown, during Trump’s first term over his demands for funds to build the U.S.-Mexico border wall, ended in 2019 after 35 days.

Meanwhile, the Trump administration is exercising vast leeway both to fire workers — drawing complaints from fellow Republicans and lawsuits from employee unions — and to determine who is paid.

That means not only military troops but other Trump administration priorities don’t necessarily have to go without pay, thanks to the various other funding sources as well as the billions made available in what’s commonly called Trump’s One Big Beautiful Bill Act that’s now law.

The Pentagon said over the weekend it was able to tap $8 billion in unused research and development funds to pay the military personnel. They had risked missed paychecks on Wednesday. But the Education Department is among those being hard hit, disrupting special education, after-school programs and others.

“The Administration also could decide to use mandatory funding provided in the 2025 reconciliation act or other sources of mandatory funding to continue activities financed by those direct appropriations at various agencies,” according to the nonpartisan Congressional Budget Office.

The CBO had cited the Department of Defense, the Department of the Treasury, the Department of Homeland Security, and the Office of Management and Budget as among those that received specific funds under the law.

“Some of the funds in DoD’s direct appropriation under the 2025 reconciliation act could be used to pay active-duty personnel during a shutdown, thus reducing the number of excepted workers who would receive delayed compensation,” CBO wrote in a letter responding to questions raised by Sen. Joni Ernst, R-Iowa.