>> good evening and thanks for joining us. breaking news as the government officially shuts down at midnight for the first time in nearly two decades after a budget stand off over obama care. the president just released a message to the troops assuring them that they will remain on active duty. >> congress has not fulfilled its responsibility. it's fled to pass a budget. and as a result much of our government has now shut down until congress funds it again. >> washington d.c. alone now likely to lose around $200 million a day. growth expected to slow. but in just a few hours, the affordable care act will still roll out as planned. love it or hate it, obama care won't change some fundamental issues. like some companies, giving employees the option to go abroad for cheaper medical care. already more than a million a year travel out for necessary procedures and there could be more now.

could this become the new face of health care? >> this is my family. they're all going to the airport with me. i have everything. >> tonight joy, age 39, married mother of two, leaves on a journey. leaving north carolina to save her life and not kill her family savings. >> i'm going to miss my family a whole lot. so i'm scared. >> with a family history of diabetes and heart disease, she's going to the only place she can afford gastric bypass weight loss surgery. her destination, costa rica. a tourist hot spot and booming in the business of medical tourism. for joy it will be an adventure of a lifetime. all of this paid for by her employer. >> i guess this is it. >> joining her on the trip is gary harwell, 65. >> i just want it to be over so

he won't hurt so bad. >> your first plane ride. >> i know. i'm so excited. >> doing things well. >> with an annual salary of $28,000. even with insurance she couldn't afford the out of pocket expense. >> could you have afforded this procedure on your own? >> no. >> gary's procedure worked but he was prepared to live with severe near pain. >> it is for me to get things taken care of. >> so it's that important to you to get things done? >> yeah. i feel like i'm slowing her down. and i'm slowing me down because i'm not able to do the things

that i need to do. >> both did their research. gary and the doctor earned his medical degree and received additional training in the u.s. >> i ask this question respectfully. how does your training compare with an american physician? >> i don't want compared. i am just another option. >> they are a part of a growing wave of americans frustrating with the cost of health care. but here's what's new. their company back home in western carolina is paying the entire bill. everything. four star resort hotel where they will stay for at least a week. and then there is the personal driver. a built in best friend, what's called a patient assistant along to fill out forms, answer questions including translation. and the love doesn't stop there.

a private room in a private hospital with a pull out bed for guests and the pampering comes from the surgeon who offers reassurance in one of the many scheduled consultations. >> you have somebody here? >> no. >> don't worry. we will be your family here. >> it was enough to move joy to tears. in the u.s., gary's knee replacement would have cost more than $50,000. in costa rica, it's half that. back home, joy's surge is 30,000. here less than 18,000. in the u.s. they would have each paid $3,000 out of pocket. in costa rica, nothing. their employers say it just makes economic sense. they have sent close to 200 employees abroad for surgery. >> the fact that you have decided to give your employees an option a chance to go abroad

for health care, what does that say about the american health care system? >> the american health care system is broken at the moment. >> how? >> the error rates are probably the high nest the world. the cost is also the highest in the world. >> what will obama care mean, do you think, for medical tourism? increase it? decrease it? >> i think it will increase because companies will be looking to reduce costs. >> so you expect this surgery will change your quality of life? >> certainly. without a doubt. >> joy and gary could back out at any time. but they are going through with it. >> what have your friends said about it? and that it's going to cost you nothing. >> you lucky dog. really? who do you work for? i wish that we was offered stuff like that. >> did you sleep much? >> yeah, as a matter of fact, i slept very well. >> day three. it is 4:55 a.m., way early in the morning and gary is headed

to the hospital for his surgery. >> and waiting at the hospital door is gomez, gary's patient assistant. a kind of personal escort. his knee surgery will take nearly two hours. we noticed during gary's procedure that much of the equipment is actually made in the u.s. >> there were certain pieces of equipment that they were using and made in the united states but it was cheaper for them to purchase in costa rica than here at home. we had two partial knee replacements. $90,000 for the two devices alo alone. that is probably $3,000 for those devices. >> so the economics you just couldn't ignore? >> no.

>> after successful surgery, gary heads to recovery. about that time -- >> i am ready. joy shows up for a gastric sleeve surgery. that's where we heard another american voice. next to joy is fay holmes. she and her husband moved here in part because of the cheap quality health care here. >> you talk to friends in the states considering going abroad for surgery, what would you say? >> i say that's a really good idea. >> what were your thoughts? >> hell yeah. her procedure also goes well. there is one more bonus. when the bandages come off, each will receive a check for at least $2500, a percentage of the

money saved in insurance costs. that sounds like a win win for everybody. >> it is. it has to be. as i have said all along, it is kind of a no-brainer. >> the medical experts who are tracking the increasing number of americans now more than a million going abroad for medical procedures are concerned. >> the biggest risks are an inabltd to sue for medical malpractice risk of getting an infection. risk of a poorly performed procedure. >> daily visits from a private nurse, access to free cell phone service to call home. >> even though it's for my health, that's my benefit. and the rest is to help us all. it's a wonderful thing. christmas is coming right around the corner. and so, it's all like a win-win

situation to me. >> getting paid to go abroad for medical care is tough to compete with. thanks byron. for the latest on the shut down stay with abc news. good morning america will have full coverage in the morning. >> abc news night line brought to you by viagra. ♪ [ alarm sound for malfunctioning printer ] [ male announcer ] you've reached the age where you've learned a thing or two. [ metal clanks ] ♪ this is the age of knowing what you're made of. so why let erectile dysfunction get in your way? [ gears whirring ] talk to your doctor about viagra. 20 million men already have. ask your doctor if your heart is healthy enough for sex. do not take viagra if you take nitrates for chest pain; it may cause an unsafe drop in blood pressure. side effects include headache, flushing, upset stomach, and abnormal vision. to avoid long-term injury, seek immediate medical help

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she dropped her kids off at the school bus with her husband and they went their separate ways. what he did next tortures her to this day. her high school sweetheart committed a mass murder at a school. what drove him to open fire on innocent children? for the first time marie is opening up about what she thinks happened that day. >> marie is still haunted by her last phone call with her first love. >> to hear the words from a man you have been married to for almost ten years and have him say i am not coming home, my brain was trying to prehend what he could mean. >> just that morning everything seemed so routine. >> charlie walked down to the bus stop that morning. >> he told him that he loved

them. >> did it seem unusual? >> looking back on it, it was definitely a distinct moment. >> now on the phone, suddenly she knew. >> i knew he was serious. he was telling me that it was too late. >> there has been another school shooting. >> too late for marine to stop the horror of that day. she had no idea he would take others as well. it's been seven years since he stormed a one-room amish schoolhouse before he killed five and taking his own life. >> these victims were shot execution style in the head. >> marine, the one person who may have an answer to why this

had to happen spoke with me for the first time. >> it's a question that everybody has from the outside looking in is why. >> what i heard from charlie is about the loss of our first daughter. and in some way he felt like he was getting back at the lord for the loss that we had sustained. >> that's not rational. >> that's not a rational reason. people make choices and they don't always make good choices. >> do you believe your husband was mentally ill? >> on that day he was absolutely mentally ill. i don't see how someone could do something like that and not be. >> but he planned it out? >> it was suggested to me that all of those years with undealt with depression resulted in a psychotic break. >> what were the days and weeks leading up to the shooting. >> there was heaviness the weekend before. you say what were the signs and

how did i mess them and how did i not see any of them coming? i knew how distant our hearts had been. >> this completely surpasses them. >> their innocence was gone. i was soaking in the moment of this could be the end of that sound. >> of laughter? >> of laughter. and what if i never hear it again? >> did you struggle with the guilt of having your kids? >> i think the amish families spared me a lot of that. their concern for us. the way that they came so quickly to make sure that they're all right. all right. >> members of the amish

community came to lift marie's guilty. >> i knew that was not coincidence. i couldn't hear the words that they were saying but i could see the exchange that was happening. i could see the way they laid their hands on my dad's shoulder. i could feel it. the forgiveness and concern. it said everything. >> at charlie's funeral, the amish formed a line to shield marie's family from the press, sacrificing their tradition against having their photos taken. >> it was one of those moments during the week where my breath was taken away but not because of the evil, but because of love. >> maria started to pick up the pieces. their children from previous marriages not part of their own

family. the greatest difficulty is reconciling that the man she loved was also a murder. >> tell me about the charlie you fell in love with. i loved the way he was so tender with them. to me that was a mark of somebody who had the potential to be a really good dad. >> what do you want people to know about charlie beyond what we know. >> it was almost like they were two entirely different people. the one i knew and loved and had a family with. two completely different people. >> forgiving that man she didn't know. >> give charlie for him. i have to forgive him so that i

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>> tonight, a feed frenzy all about being broken. for anyone still not convinced that "breaking bad "has seeped into the american psyche, the main character has been a proponent of the affordable care act. the law supporters claim white would have had far fewer expenses under obamacare while opponents aren't buying it saying the star doctors like white will be harder to use

under the law. stunning video. a family in an suv targeted by a pack of motorcyclists in the middle of the day. they are stopped and then surrounded on a busy new york parkway. the driver makes an apparent attempt to escape but the cyclists go after him eventually dragging him from the car and beating him. >> how many people see water spouts and tornados from this perspective. >> for good reason. they can pack a serious punch. >> glad he's laughing. thank you for watching abc news. world news now is coming up soon with overnight breaking news. i will see you on good morning

america. good night. "omg! insider" -- the top trending stories you need to know. >> kim's first public post-baby appearance days before kanye's court date. >> will prosecutors use kanye's greatest hits against him. >> this could be really challenging for the defense. and is khloe in or out? is she finally filing for divorce. ryan cranston and the party after "breaking bad." >> that's awards. >> plus, kaley cuoco with her it.fiancee. katy perry's new interview. and o'reilly on miley. >> you don't need to do these stunts. bill's controversial new book and casting the newnew jf movie. >> kim kardashian playing jackie o. and -- "china beach" 25 yeary"gñ later.

>> it changed my life. it changed my career. it changed me. >>ziwñ dana's tears. a reunion event. >> i had a hard time shutting us up. now where yahoo! broadcast meet for 24/7 access to celebrity news, "omg! insider." the "breaking bad" series finale delivers on meth, mayhem and and murder. hello, everyone. i'm kevin frazier. >> i'm thea andprups a huge night sending social media into a frenzy. but sending the media into a frenzy today. reports khloe could finally be filing for divorce from lamar odom. that fourth anniversary didn't go so well. >> meanwhile, a kinder and c8 gentler kanye hit up fashion week with kim by his side. and where's baby north? we'll get to it all as we take a look at the khian chaos. kim and kanye hiut)jt s hands and posing for photographers. kim showed off herardas curvy post-baby body in her first public appearance since the birth of little baby north. the new parents who left the 3-month-old girl behind had a

front row seat at the givanchi fashion show. today the couple hit the streets kim in a short qform-fitting out dress. meanwhile, a new report out today says khl]bgç kardashian i about to file for divorce from lamar odom. couple together on last night's episode of "keeping up with the kardashians" which featured kim's baby shower. >> and i can't wait until this baby is born. you make mthe so happy. >> kim on anxiety overload waiting for kanye who showed up late. >> just like a really special eend.t to see him come at the >> back in paris, kanye's %9 >> you may have noticed kanye is on his best behavior with paparazzi in paris. that's because it could have an impact on his misdemeanor battery case which involves an incident with paparazzo at iññ l.a.x. darren kavinoky who is following the case says the rapper's greatest hits couldvfd played for the jury when kanye