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ST. CLOUD, Fla. — Florida chef Elijah Button was chopping onions in June when his knife slipped and sliced his middle finger to the bone.

It was his worst kitchen accident to date. But having given up his Affordable Care Act health insurance plan in January because of a $100 monthly premium hike he couldn’t afford, the 21-year-old in St. Cloud didn’t have the money for emergency care.

“Going to the hospital for it wasn’t even an option,” he said, gesturing toward his finger before preparing a pot roast for his aunt and uncle in their suburban home. “My first thought was, ‘how am I going to fix this?’”

After Republicans in Congress let enhanced federal subsidies for Affordable Care Act health plans expire in January, millions of Americans including Button had to decide whether to keep insurance that often doubled or tripled in cost — or risk going without it.

Months later, with no action from lawmakers to replace the lost funds, they’re facing the consequences. Some are dealing with strained budgets and exorbitant medical bills, while others avoid the doctor in fear of the cost.

Florida, whose large population of gig workers, entrepreneurs and small business owners relies heavily on the federal health insurance marketplace, has become one of the nation’s most visible epicenters of that impact.

Figures first reported by The Associated Press showed that about 440,000 Floridians dropped their Affordable Care Act plans this year — more than in any other state. Thousands more who kept coverage are struggling to get by, as prices of necessities like groceries and gasoline remain steep, and health insurers project another year of double-digit premium hikes.

While Florida had the most affected residents, its struggles are reflective of broader nationwide concerns over rising healthcare costs and a lack of meaningful policy to address them.

In the deep-red state where congressional districts were recently redrawn to strongly favor Republicans, the cost of healthcare is a major campaign issue. Republican midterm candidates have been promoting fraud crackdowns to protect federal health programs, while Democrats have been urging voters to help Congress change hands so they can restore subsidies.

Button, who is estranged from his parents, asked his uncle for help with his bloodied finger. With a butterfly bandage, splint and daily cleanings and dressings, it healed. But the scar still gnaws at Button as a symbol of what else could go wrong.

“It just feels like I’m living in a house of cards,” he said.

Florida’s population and politics make it ground zero for ACA fallout

Last fall, debate over the expiring subsidies consumed Congress, resulting in a record 43-day government shutdown as Democrats insisted on extending the COVID-era assistance and most Republicans refused.

Fast forward almost a year and lawmakers rarely reference the topic anymore. The administration says it is addressing affordability with fraud-busting efforts and deals with drug companies, but Congress hasn’t passed any significant legislation to lower health costs.

In part due to its large number of construction, hospitality and small business workers — and also because its Republican-led legislature never expanded the Medicaid safety-net health program — Florida has the largest Affordable Care Act enrollment in the country. At just over 3.8 million enrollees, it represents about a fifth of the nation’s total enrolled population.

Of the roughly 443,000 Floridians who left the marketplace, most are likely going without insurance, according to Cynthia Cox, a vice president at the healthcare research nonprofit KFF. She said that’s because it is typically a “place of last resort” to get coverage.

The data doesn’t tell the stories of those who kept insurance. Tracy Rand, a licensed mental health counselor in Leesburg, Florida, is one of them.

Ever since getting her ovaries removed last year due to benign but painful tumors, she has had severe menopause symptoms that require medication, including an overactive bladder and hot flashes that cause piercing headaches.

She uses clear plastic containers to organize the more than 30 medicines and supplements she takes daily, their bottles crammed into a living-room drawer and a tray on her kitchen counter.

The 51-year-old’s Affordable Care Act plan was going to surge in price this year from $55 a month to $1,100 a month, so she downgraded. Her new plan, with higher deductibles and copays, costs $160 a month.

To make that work in her budget, Rand quit a doctoral program she was working toward, started buying groceries at cheaper stores, gave up once-monthly dinners out with her husband and stopped meeting friends regularly at a paint-your-own pottery studio.

It’s been a difficult adjustment, but a necessary one for her health.

Rand said the prospect of insurers raising rates again fills her with dread.

“I don’t know what else we can get rid of,” she said, covering her face with her hands. “I don’t know if we’re going to have to file bankruptcy.″

Clinics for the uninsured are a saving grace — but they can’t take everyone

In Orlando’s leafy, brick-paved neighborhood of Colonialtown South, Tarsha Watson found her lifeline. A clinic there called Grace Medical Home provides low-income, uninsured Floridians with comprehensive care for a $5 per-visit fee.

Watson, 54, has a master’s degree in business administration, but she hasn’t been able to find work since losing her job two years ago. That means she doesn’t have health insurance. When she explored Affordable Care Act coverage, she was quoted $600 per month, far out of her reach.

At Grace, Watson learned her blood sugar is high and that she needed to lose weight. Now, she walks laps around her backyard pool and does Tai Chi YouTube tutorials to focus on fitness. She said she wishes everyone could have her experience.

“It’s very hard out here,” she said. “It’s not enough.”

At the clinic, patients cycle in and out of a wide hallway lined with appointment rooms as doctors scan supply shelves for complimentary over-the-counter medications. The expansive building has separate areas for dental, mental health, vision and pediatric care.

CEO Stephanie Garris said it’s one of 110 free or charitable clinics in Florida, but that’s not enough to handle demand. To treat more people in response to the Affordable Care Act changes, it recently started hosting a mobile acute care clinic for walk-in patients.

Garris said Grace Medical Home treated about 1,350 people last year. Every year, they take about 350 new patients.

“Would I love to double that, triple that? Of course,” Garris said. “I just think in the reality, with the huge number of uninsured that we have, it’s just not possible.”

Health costs become an issue in midterm campaigns

For U.S. Rep. Darren Soto, a Democrat defending his seat in a sprawling — and now much redder — redrawn district south of Orlando, health costs are a campaign focal point.

He said his district, which is near various theme parks, had the second-largest Affordable Care Act enrollment in the nation, in part because many small tourism businesses can’t offer employees health insurance.

“I just hear it everywhere I go,” he said. His Republican opponent, Navy veteran and former Trump administration official Dan Green, did not answer emailed questions about the subsidies but has emphasized affordability of groceries and property insurance as campaign priorities.

Soto voted with Democrats and some Republicans — including a few from Florida — to save the subsidies last year. The Republican majority declined and suggested other ideas, including funding Americans’ health savings accounts. No law along those lines has passed yet.

Button, a Democrat in Soto’s district, said he is open to different reforms for health costs, but said politicians aren’t acting fast enough.

“They keep trying to make excuse after excuse,” he said. “I don’t have six months to a year to wait for you guys to pass this through the hoops that you need to.”

Swenson and Martin write for the Associated Press.

Taipei, Taiwan – China’s coastguard and civilian fleet are expanding their presence in the waters east of Taiwan, raising fears that Beijing may be rehearsing a containment strategy that would cut off the self-ruled island from outside trade and assistance.

Through June and July, China’s Maritime Safety Administration and coastguard staged multiple patrols and “special maritime law enforcement operations”, according to official government announcements.

While China regularly patrols the Taiwan Strait – the waterway with an average width of about 180km (112 miles) separating coastal China from the main island of Taiwan – this marks the first time the patrols have moved east of Taiwan in such quick succession, according to analysts.

K Tristan Tang, a nonresident fellow at the United States-based National Bureau of Asian Research, said the shift carries both strategic and symbolic weight for Taiwan.

“Beijing is signalling that it wants to extend its claimed administrative jurisdiction to Taiwan’s eastern waters, effectively surrounding Taiwan rather than only eroding Taiwan’s space in the strait,” Tang told Al Jazeera.

“Law enforcement operations” have included patrolling the area and requesting information from commercial vessels about their origin and destination, according to Taipei.

The shift east has also occurred amid a greater uptick in Chinese maritime activity around Taiwan and its outlying islands. Taiwan reported 55 sightings of Chinese coastguard and research vessel activity in June, up from 30 sightings in May.

These sightings included Chinese activity near the uninhabited Taiwan-controlled Dongsha Islands, also known as the Pratas Islands, in the South China Sea.

Beijing has said the operations are a response to talks between Japan and the Philippines to set their maritime boundaries, which infringe on “territorial sovereignty as well as its maritime rights and interests”, according to Chinese state media.

Some of the waters around southern Japan and the northern Philippines overlap with Taiwan’s Exclusive Economic Zone (EEZ), which extends 200 nautical miles (370km) from its coastline.

On July 4, China’s coastguard announced that law enforcement activities to the east of Taiwan would continue to “firmly safeguard China’s territorial sovereignty and maritime rights and interests”.

China claims Taiwan as a province – which means it also views Taiwan’s EEZ as under its jurisdiction. It also claims large swaths of the nearby South China Sea and East China Sea, some of which are disputed by Japan, the Philippines, Vietnam, Malaysia, Indonesia and Brunei.

China’s Ministry of Foreign Affairs has previously told reporters that its activities near Taiwan are “legitimate actions to exercise China’s jurisdiction, safeguard regional stability and uphold order at sea in accordance with the law”.

The Chinese embassy in Washington, DC did not immediately respond to Al Jazeera’s request for comment.

‘Grey zone’ tactics

Ray Powell, founder and director of Sea Light, a maritime transparency project based at Stanford University, said he views the uptick in patrols as part of China’s “boa constrictor strategy that intends to squeeze Taiwan one coil at a time”.

China has pledged to annex Taiwan by peace or by force, and it employs a variety of pressure tactics, from cutting off access to international spaces such as the World Health Organization, drone and fighter jet incursions, to alleged cyberattacks, according to Taiwan’s National Security Bureau.

Known as “grey zone” tactics, these manoeuvres are designed to strain Taiwan’s limited resources and damage morale in order to convince its 23 million people that annexation is inevitable, according to Taiwanese officials.

Security analysts like Powell have warned that “law enforcement” activities could quickly escalate into a blockade or quarantine. Taiwan is particularly vulnerable to this type of pressure as an island that imports nearly all its energy supplies.

“One day we could look back at this and say this was in some ways the start of the quarantine,” he told Al Jazeera.

“Today it’s radio challenges; what is the next stage after that? When do we start to see them stop and inspect ships or reroute them? It’s not a very big step to start squeezing Taiwan on things it needs, like LNG,” Powell said.

China has already signalled that a blockade could be on the table in the future. Since 2022, Beijing has regularly staged large-scale military exercises in the Taiwan Strait, including a simulated blockade of the island during its last round of exercises in December.

While coastguard activity is more low-profile than a naval patrol, Chauluen Lin, an expert in asymmetric warfare at Taipei’s Institute for National Defense and Security Research, told Al Jazeera the fleet could be considered a “second navy”.

China’s coastguard is not a civilian police force, as it falls under the jurisdiction of the Central Military Commission as a division of the People’s Armed Police.

China’s coastguard patrols have been unusual enough to elicit a rare joint response from the United Kingdom, Germany and France, who said in late June that the “actions threaten regional stability and the freedom of navigation and safety of international shipping”.

“We reiterate our opposition to any unilateral change to the status quo, particularly by threat or use of force or coercion,” the statement said.

US Secretary of State Marco Rubio said last week that Washington disagrees with the expanded patrols and that they undermine regional stability.

A distracted US

William Yang, the Crisis Group’s senior analyst for Northeast Asia, told Al Jazeera that Beijing may be taking advantage of a US distracted by the war in Iran and a president who appears ambivalent towards Taiwan.

Although the US does not recognise Taiwan as a country, it has pledged to help the island defend itself. Much of this assistance has come in the form of weapons sales, training and intelligence sharing.

US President Donald Trump also cast doubt on these commitments when he said US weapons sales could be a “negotiating chip” with China following a meeting with Chinese leader Xi Jinping in May.

“The external environment has fundamentally changed in the Indo-Pacific region, at least from their perspective, with Washington very focused and tangled up in the Middle East,” Yang said.

“At the same time, the US has no bandwidth to really look at or respond to such an expansion of Chinese maritime operations in these sensitive waters,” he added.

WASHINGTON — A year after the Trump administration kicked off its aggressive immigration enforcement tour with military-style raids across greater Los Angeles, federal officials have veered toward a less flashy but broader strategy: making immigrants’ lives harder so they will leave.

The changes range in scale and scope, from disqualifying immigrants from certain jobs to indefinitely pausing the processing of visa applications. They target those lawfully present as well as the undocumented.

Since President Trump’s second term began, the administration has used executive orders and federal regulations to chip away at services or benefits, such as work permits and small business loans, that immigrants could obtain in the past.

Now, immigrants are finding that freedoms — the ones that once made the U.S. a desirable place to start over — are disappearing. Many are retreating back into the shadows as they fear previously routine tasks, such as traveling across states, filing taxes and seeking medical care.

“The priority is to force people to leave the country or not come, regardless of legal status or really any other criteria,” said David Bier, immigration studies director at the Libertarian think tank the Cato Institute. “They’re taking a sledgehammer to the system.”

Trump won the White House in part on his promise to clamp down on illegal immigration, but recent polling shows support for his agenda has waned, especially after immigration agents shot and killed two U.S. citizens in Minneapolis.

In a statement, White House spokesperson Abigail Jackson said Trump’s highest priority has always been the deportation of immigrants with criminal records. The Department of Homeland Security said Trump also prioritizes immigration that strengthens the country financially, socially and culturally.

President Trump displays the signed “Secure America Act” during a ceremony in the Oval Office on Wednesday. The act provides $70 billion for immigration enforcement and border-security agencies.

(Aaron Schwartz / CNP, Bloomberg)

The number of arrests by ICE agents has declined. On average, ICE arrested about 1,000 immigrants per day in early March, down from a peak average of just under 1,400 in mid-January, agency data show. And there are fewer detained immigrants — facilities across the country held about 60,000 detainees in April, compared to more than 70,000 in late January.

The downturns prompted some Trump loyalists to say the administration is failing to fulfill his signature promise, which is an assertion the administration rejects.

“ICE is NOT slowing down,” said Homeland Security spokesperson Lauren Bis. “Since Day One, DHS law enforcement has been delivering on President Trump’s promise to the American people to arrest and deport criminal illegal aliens.”

At a border security conference last month, Tom Homan, who leads border policy for the White House, suggested immigration agents would return to more muscular enforcement tactics.

“You ain’t seen s— yet,” he told the audience.

But along with focusing on deportations, the administration is deploying other tactics to deter illegal — and legal —immigration.

ICE agents confront protesters on June 8 as they gather outside the federal immigration center at Delaney Hall in Newark, New Jersey, where ICE is housing detained immigrants.

(Spencer Platt / Getty Images)

Curtailing visas

Last month, the Department of Homeland Security announced that “except in extraordinary circumstances,” immigrants seeking lawful permanent residency must leave the U.S. to complete the process. After a backlash, the administration defended the policy, saying it won’t prevent anyone who qualifies for a green card from getting one.

U.S. Citizenship and Immigration Services, the agency in charge of processing immigration benefits, has upped security screening since Trump took office. The agency says that’s to root out fraud, but critics say all it does is unnecessarily slow down a system that already vets applicants vigorously.

The administration indefinitely banned people from 75 countries from receiving immigrant visas, which allow people to move permanently to the U.S.

In a similar move, the government halted the processing of immigration applications for people from 39 countries and who are already in the U.S. On June 5, a federal judge struck down the policy in a scathing ruling that said the administration “justifies its actions with pretextual concerns of ‘national security’ that mask anti-immigrant sentiments.”

Children of Guatemalan origin, from left, Areimy, Mariela and Enrique, arrive at Miami International Airport on Dec. 4, 2025, as they prepare to leave the United States to reunite with their recently deported parents in Guatemala.

(Chandan Khanna / AFP via Getty Images)

The judge’s ruling may offer relief, but for many immigrants, the effects of the policy are devastating. Armin, a 42-year-old from Iran, said he has racked up more than $15,000 in debt since the pause took effect in December. Armin asked The Times not to fully identify for fear of jeopardizing his immigration case.

The nutritional scientist came to the U.S. in 2019 on a student visa and has a pending green card application under a provision that allows certain highly skilled immigrants to apply for permanent residency without needing an employer to sponsor them.

After receiving his PhD and completing a postdoctoral program, Armin was in between jobs when he received a research grant in November. But with the processing of his work authorization halted, the university that issued the grant said it couldn’t hire him as a research associate. In February, he was turned down for another job.

Armin said he is confused about why the administration won’t differentiate between legal immigrants and those who should be deported.

“I can’t believe it,” he said. “I’m doing research and my research has national interest benefits. You expect support from the government. Unfortunately they don’t differentiate. They don’t care about your resume.”

Bier said the visa policies affect half of all legal immigrants coming from abroad. He published a report in April about how Trump has cut legal immigration far more than illegal immigration, noting that the administration’s policies have led to big drops in visas for international students, high-skilled workers and refugees.

“The legal immigration system is being used as a means to carry out the mass deportation agenda,” he said.

Alessandro Negrete, who lived most of his life in the U.S. undocumented, crosses into Mexico after deciding to leave.

(Robert Gauthier / Los Angeles Times)

Encouraging self-deportation

More than 90,000 immigrants have been granted voluntary departure since the start of the Trump administration, according to federal immigration court data through April that was analyzed by TRAC, a data research organization. Voluntary departure avoids official deportation and can leave open the possibility of an immigrant returning to the U.S. legally.

Homan, who declined to be interviewed for this story, has said self-deportations were part of the administration’s immigration plan all along.

“We knew if we surged unlimited ICE resources in the interior, and we do these operations, that that will force those that are here illegally to leave on their own,” he recently told the Washington Examiner.

Halting work permits

In the past, asylum seekers and others with deportation protections have had the ability to seek permits to work legally in the U.S. But work is now an administration target.

One proposed regulation would prevent asylum seekers from working legally in the U.S. Another proposal, published Friday, would further restrict access to work permits for other immigrants.

Under a rule that took effect last month, asylum seekers pay an annual $102 fee within 30 days of receiving a notice from U.S. Citizenship and Immigration Services. If the deadline is missed, their applications will be rejected — with no opportunity to appeal — and they could be placed in deportation proceedings. Those who apply for asylum with the agency have entered the U.S. legally, such as on a visa, and are not undocumented.

Asylum seekers rest at a Tijuana migrant shelter a day after President Trump began his second term in the White House.

(Robert Gauthier/Los Angeles Times)

Conchita Cruz, co-executive director of the Asylum Seeker Advocacy Project, said many asylum applicants have not received notice that the fee is due.

Cruz said she believes the Trump administration is using these changes as an excuse to dismiss people’s asylum claims. While the president has the power to decide whether to offer or rescind humanitarian programs, such as Temporary Protected Status, the right to seek asylum is enshrined in law.

“We’re worried this is a pretext for people to fall out of the asylum system and fall out of the workforce,” she said.

The processing of work permits has already been slowed, leaving many immigrants who still qualify for employment authorization unable to work.

During a House Homeland Security Committee hearing last week, Rep. Lou Correa (D-Santa Ana) asked Homeland Security Secretary Markwayne Mullin to help him speed up the work permit renewals for two police officers who were recently fired by agencies in his district because their DACA status expired.

Mullin said he would help but that Congress ultimately must pass a permanent solution for DACA recipients.

“These are police officers on Main Street, sir,” Correa responded.

“Not all of them are,” Mullin said. “I’m not just going to wave a magic wand and fix them all.”

“You have that magic wand — that’s your job,” Correa said.

It wasn’t just Democrats complaining about slow processing. Rep. Gabe Evans (R-Colo.) similarly asked Mullin for help because many of his constituents — “farm workers, youth ministers, nurses, grocery store business managers” — who have lived and worked in the U.S. legally for decades are now having trouble renewing their visas.

Secretary of Homeland Security Markwayne Mullin, left, and President Trump, center, walk to the motorcade after exiting Air Force One at Joint Base Andrews, Maryland, on May 20.

(Kent Nishimura / AFP via Getty Images)

Calls for mass deportations

Mullin, who took the reins in March after Trump fired his predecessor, Kristi Noem, rolled back some of Noem’s policies, including telling agents to stop entering homes without judicial warrants and canceling some contracts she had initiated.

But the changes and the downturn in arrests have drawn criticism from some fervent Trump supporters.

“Trump’s legacy is tied up in this,” said Mike Howell, a former DHS attorney who founded a group called the Mass Deportation Coalition. “It’s going to be hard to tell a younger voter to get excited to show up when one of their top issues is mass deportation and, a year and a half in, it doesn’t appear it’s going full-steam ahead.”

Howell said enforcement at work sites is critical to scaling up arrests and deportations. That more such operations haven’t happened, he said, is a political decision to appease wealthy donors and special interest groups who don’t want to see their workers deported.

The architect of Trump’s immigration agenda is Stephen Miller, a top White House aid who has called for a “moratorium on immigration from third-world countries,” demanded 3,000 arrests per day and said that immigrants and their descendants “recreate the conditions, and the terrors, of their broken homelands.”

Royce Bernstein Murray, a former Homeland Security official who worked on immigration policy under the Biden administration, said the winding down of flashy enforcement surges has given the administration more time to “focus on tearing down the legal immigration system.”

“This is Stephen Miller’s sweet spot,” she said. “He was never in enforcement — he’s a policy guy. This is really an opportunity for him to make good on all he has planned for years.”

While ICE has, in recent months, returned to its more conventional targeted enforcement tactics, Homan has sought to make clear that mass deportations are still a goal.

“For the people out there saying ‘President Trump’s getting weak on mass deportation,’ you don’t know what the hell you’re talking about,” Homan said at the border expo.

On Monday, Homan told Fox News that he had just reviewed plans for an ICE operation that would surge agents to New York City.