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The lawsuit over the payments was originally brought by House Republicans against the Obama administration. House Republicans won the lawsuit, which was appealed. Now, it has been inherited by the Trump administration, which has been unclear about whether it will defend the payments. A status update on the case is due on Monday.
Trump and Congress have sent mixed signals about whether the payments will continue on an almost weekly basis.
[Health insurers asked the Trump administration for reassurance on Obamacare. They didn’t get it.]
The repercussions of discontinuing the payments have been made clear by insurance executives, who warn that if the funding disappears, insurers could leave markets altogether or raise their premiums significantly.
CareFirst Blue Cross Blue Shield, the largest insurer in the Mid-Atlantic, requested rate increases of more than 50 percent in Maryland's marketplaces, and chief executive Chet Burrell warned earlier this month that if cost-sharing reduction payments were to end, rates could increase by another 10 to 15 percentage points.
Anthem chief executive Joseph Swedish said in an April earnings call that the company was filing its preliminary rates with states under the assumption the cost-sharing reductions would be made. If there isn't a commitment to make the payments, Swedish said the company would change its plans.
“Such adjustments could include reducing service area participation, requesting additional rate increases, eliminating certain product offerings or exiting certain individual ACA-compliant market altogether,” Swedish said.
The National Association of Insurance Commissioners sent a letter this week to senators and to White House budget director Mick Mulvaney stressing the importance of the payments.
“This is not a theoretical argument — carriers have already left the individual market in several states, and too many counties have only one carrier remaining,” the association wrote to Mulvaney. “The one concern carriers consistently raise as they consider whether to participate and how much to charge in 2018 is the uncertainty surrounding the federal cost-sharing reduction payments.”
The motion to intervene was filed by the attorneys general of New York and California, and was joined by Connecticut, Delaware, Hawaii, Illinois, Iowa, Kentucky, Maryland, Massachusetts, Minnesota, New Mexico, Pennsylvania, Vermont, Washington and the District of Columbia.
“The President has increasingly made clear that he views decisions about providing access to health insurance for millions of Americans — including the decision whether to continue defending this appeal — as little more than political bargaining chips,” the attorneys general wrote in their motion to intervene in the case, saying they could not depend on the White House to represent states' interests.
“The number of uninsured Americans would go back up, hurting vulnerable individuals and directly burdening the States,” they wrote. “The wrong decision could trigger the very systemwide 'death spirals' that central ACA features, such as stable financing, were designed to avoid.”
Read More:
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Iowa Obamacare program on verge of collapse as congressional uncertainty takes its toll
Free-standing ERs offer care without the wait. But patients can still pay $6,800 to treat a cut.
2 Journalists Killed During Live Broadcast In Virginia; Suspect Has Died
Enlarge this image toggle caption DAVID MANNING/Reuters /Landov DAVID MANNING/Reuters /Landov
(This post was last updated at 3:43 p.m. ET.)
Two journalists for Virginia TV news station WDBJ were killed by a gunman Wednesday morning while they were broadcasting live at a waterfront shopping center about an hour southeast of Roanoke, Va.
Reporter Alison Parker and photojournalist Adam Ward were doing a live report from Bridgewater Plaza in Moneta when a gunman opened fire, killing Parker and Ward and injuring Vicki Gardner, the head of a local Chamber of Commerce who was being interviewed. Gardner is now in stable condition, hospital officials say.
A suspect in the shooting was quickly identified — in part because of video taken at the scene — as Vester Lee Flanagan, 41, a former reporter for the station who was also known as Bryce Williams.
toggle caption Twitter
Franklin County Sheriff Bill Overton says Flanagan has died. He had suffered a gunshot wound when he was taken into custody by Virginia State Police after a car chase that came hours after the shooting; authorities earlier said Flanagan was in critical condition.
At a 2:15 p.m. news conference, Overton said that less than an hour earlier, Flanagan had "died at Fairfax Inova Hospital in Northern Virginia, as a result of a self-inflicted gunshot wound."
In an earlier statement, Virginia State Police described how the shooting suspect had fled and eventually reached Interstate 66, with police in pursuit.
The suspect refused to stop, ran off the road and crashed. When police approached the vehicle, they found he had suffered a "gunshot wound." The man, police said, was taken to a hospital with "life-threatening injuries."
In an interview with CNN, Jeffrey A. Marks, WDBJ-TV's general manager, said Flanagan was hired as a reporter, but about two years ago he was fired. During a separate broadcast on his network, Marks said Flanagan had filed a complaint with the U.S. Equal Employment Opportunity Commission after he was fired.
The station reports:
"This happened during a live broadcast around 6:45 a.m. ... "Adam was 27-years-old. Alison just turned 24. "Both were from the WDBJ7 viewing area."
Video shows the camera panning to Parker in the middle of an interview as the gunman opens fire. Parker can be heard screaming.
The final image in the video shows the camera falling down and the feet of the presumed gunman walking out of the frame.
Hours after the shooting, a video from the gunman's perspective was posted to Twitter and Facebook under the name Bryce Williams. It shows a gunman quietly walking up on the live broadcast, looking toward the photographer (whose back was turned) and then pointing his gun at Parker before opening fire.
A man claiming to be Flanagan also sent a 23-page fax to ABC News, in which he said he had "been a human powder keg for a while" and took action after the Charleston, S.C., church shootings in June.
In addition to the Franklin County Sheriff's Office, the FBI and the Bureau of Alcohol, Tobacco, Firearms and Explosives have sent personnel from Roanoke.
Update at 2:25 p.m. ET: Updates From News Conference
Former WDBJ employee Vester Lee Flanagan was taken into police custody after his car crashed into the median on I-66 in Virginia.
Franklin County Sheriff Bill Overton says Flanagan had switched cars, leaving his Ford Mustang at a Roanoke airport and driving away in a Chevrolet Sonic that he had rented before the attack. But the authorities tracked him as he drove up Interstate 81 and then onto I-66, and a police officer trailed him before activating her cruiser's emergency lights upon the arrival of backup.
Overton says Flanagan died at 1:30 p.m. ET, after being taken to the hospital with a self-inflicted gunshot wound.
Update at 1:34 p.m. ET. A 'Senseless Tragedy':
In a written statement, Virginia Gov. Terry McAuliffe said that he was "heartbroken over this morning's senseless tragedy."
He said that as the state reflects on the shootings, residents should also begin thinking about how to prevent these kinds of things from happening.
"Keeping guns out of the hands of people who would use them to harm our family, friends and loved ones is not a political issue; it is a matter of ensuring that more people can come home safely at the end of the day," McAuliffe said. "We cannot rest until we have done whatever it takes to rid our society of preventable gun violence that results in tragedies like the one we are enduring today."
During his regular press briefing at the White House, Press Secretary Josh Earnest said this was yet another example of gun violence that has become prevalent.
There are things that Congress can do, he said, to have a "tangible impact."
Update at 12:12 p.m. ET. Suspect Injured?:
Earlier today, WDBJ-TV, citing law enforcement officials, said the suspect had killed himself on Interstate 66 in Fauquier County. The station later retracted that report, saying Flanagan was injured but still alive and in critical condition.
Update at 12:07 p.m. ET. Suspect Filed EEOC Complaint:
On the same Twitter account that posted video of the shooting, Flanagan also made it clear that he was angry at the reporter and the photographer.
He said he had filed a report with the U.S. Equal Employment Opportunity Commission.
Jeffrey A. Marks, WDBJ-TV's general manager, confirmed that Flanagan had filed that EEOC complaint.
Citing confidentiality provisions, the EEOC said it could not comment.
Update at 11:20 a.m. ET. Presumed Suspect Posts Video:
The presumed suspect in the shooting of the two WDBJ journalists posted a video of the attack filmed from his vantage point to Twitter and Facebook.
The video, which has since been taken down, shows the gunman walk up behind cameraman Adam Ward. Ward does not appear to be aware the gunman is there. As the cameraman pans to the left and the camera is pointed at reporter Alison Parker, the gunman raises a handgun and aims it at Parker,who also did not seem aware of the shooter's presence.
The gunman fires at least six rounds.
Parker runs out of the frame before the video goes black.
The Twitter account has also been suspended.
Update at 10:39 a.m. ET. Authorities Identify Suspect:
CNN is reporting law enforcement authorities know the identity of the presumed gunman. And the network is reporting that the woman being interviewed in the video survived.
"The woman being interviewed, Vicki Gardner, executive director of the Smith Mountain Lake Regional Chamber of Commerce, was shot in the back and is in surgery, said Barb Nocera, the chamber's special projects manager."
The Stauton, Va., area News Leader is reporting:
Last month, the Seattle Parks Department ordered the destruction of a play area designed for special needs kids, claiming its four-foot rope ladder, tire swing, and "nest" made of rope and bike tires were "extreme dangers" and "hazardous conditions." That's an odd verdict: In 10 years of existence, no children were ever significantly injured on the play area equipment, according to Liz Bullard, who helped design the space. As she writes in Crosscut.com:
These simple play features may seem ordinary, but...here children with cerebral palsy, autism and developmental delays are encouraged and assisted as needed to climb and swing alongside their typically developing peers. The joy is palpable. We complied with the order, but it has left a bitter taste in our mouths. Our kids have been robbed of the simple pleasure of climbing and swinging under a beautiful tree.
The thing about kids with special needs is that they often have to spend a lot of time in less-than-fun institutions. Hospitals. Therapists' offices. Waiting rooms. The "Wild Zone," as the play area was called, was specifically "designed to provide relief from the highly controlled and often hyper-medicalized world our kids move in," writes Bullard.
One mom of a child with special needs commented on a post about the city's order, "This is a travesty!! How dare they steal the only play space in the Greater Seattle area, let alone the NW that is dedicated to creating a healthy play space for special kids where they aren't judged by their lesser abilities."
Wrote another mom: "The Play Garden is the best! My son attended preschool there for three years and I am so grateful for the Wild Zone. There was nothing dangerous about it. Nothing!"
Ah, but when you're a bureaucrat and you live in the world of what if thinking, danger is everywhere. Just imagine, "what if someone got hurt?" Look at the world that way and no play area wil seem safe enough.
This outlook seems to be sweeping Washington state. Recall that just a few weeks ago the Richland School District decided to phase out all swings because what if a child got hurt on them?
Too bad the bureaucrats never consider the reverse: What if kids never get a chance to climb a ladder, or hang from the monkey bars? What if kids with special needs know that after their doctor's appointment they will have to go straight home, because there's no place left for them to play?
At least they won't be exposed to the "extreme danger" of a tire swing.
Related: "Little Girl's Playset Is in Her Own Backyard, City Wants It Destroyed Anyway"
Fact Buster
Q: Does coffee make you dehydrated?
A: If you drink coffee regularly and don't drink too much it shouldn't dehydrate you.
Our expert: Dietitian Lisa Renn
[Image source: Reuters \| Mick Tsikas ]
Have your say Have you found coffee can make you feel dehydrated?
Conditions of Use
Have you been told that you need to drink an extra glass of water for every cup of coffee or tea that you drink?
For some time there has been a belief that drinking coffee and tea can make you dehydrated because the caffeine they contain has a diuretic effect. (A diuretic is a substance that causes your body to produce urine, and it has been suggested caffeine can do this because it increases blood flow through the kidneys.)
But is there any evidence to show that your morning cuppa needs to be offset with a big glass of water?
If you regularly enjoy a few cups of coffee or tea a day, then you can rest assured the moderate amount of caffeine they contain doesn't cause you to lose more fluid than you ingest, says Lisa Renn, accredited practising dietitian and spokesperson for the Dietitians Association of Australia.
Nor will your cuppa be any more likely to send you off to the loo than any other drink.
"There is evidence that caffeine in higher amounts acts as a diuretic in some people, but moderate intake is actually not that significant," Renn says.
A recent UK study of regular male coffee drinkers found no difference in hydration levels between those who drank four 200ml cups of coffee a day and those who drank the same amount of water.
Researchers measured the men's urine output over a 24-hour period and other hydration markers in their blood, and concluded moderate coffee intake provides similar hydrating qualities to water.
While the study focused on the intake of coffee, those who drink tea can also take heart from the results as it contains similar amounts of caffeine to coffee.
It's worth noting, the study involved men who were regular coffee drinkers and it's been suggested coffee may have more of a diuretic effect on those who do not habitually consume caffeine because they haven't developed a tolerance to caffeine. But so far the evidence on this point isn't completely clear.
How caffeine affects hydration
One of the reasons that drinks containing caffeine, such as coffee, tea, chocolate, cola drinks and energy drinks, have been given such a bad rap over the years is because caffeine is a diuretic when consumed in large doses (more than 500mg).
Diuretics make your body produce more urine, so not only do they have you running to the toilet more often, they also cause you to lose sodium and water. When you lose too much sodium and water you become dehydrated, and this can have an effect on a range of bodily functions from temperature control to absorption of food.
However, the amount of caffeine you get in a cuppa is unlikely to have these effects and it can actually contribute to your overall daily fluid intake.
"If you have to have more than four cups of coffee a day you may see a diuretic effect from that, but if your intake is less, then from a dehydration view you're going to be okay," says Renn.
Men's bodies need around 2.6 litres and women's around 2.1 litres of water a day, but this can be gleaned from a range of food and drinks other than water, including coffee and tea.
"Certainly you can be interspersing coffees and waters throughout the day, so you might have a bottle of water with you and be sipping on that most of the time, and then you might have a coffee in your break times," Renn says.
The good and bad sides of coffee
It's worth noting there are also other side effects associated with caffeinated drinks, which include:
rapid heart beat (palpitations)
restlessness and excitability

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