Billionaires have threatened to leave the state to avoid paying a tax that would replace the US government’s cuts to Medicaid.

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San Francisco, United States – Karen Sanchez has seen S, a man in his 30s with Down syndrome, every few months for the last 10 years that she has worked in an outpatient laboratory in a hospital in Antelope Valley, a rural part of Los Angeles County.

S comes with an official caretaker and breaks into a smile when he sees Sanchez, with her now familiar purple hair, waiting in the lobby. She shows him in to get his bloodwork done, and then they do not meet for the next few months.