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We could get a decision from Trump today on whether the administration will keep paying insurers for their cost-sharing reduction subsidies to low-income people. A few things to keep in mind if he stops the payments:

Expand chart

Data: Centers for Medicare & Medicaid Services; Map: Lazaro Gamio / Axios

  • Insurers have to keep providing the subsidies anyway — they just won't be reimbursed. That's why they'd respond by raising premiums for next year by as much as another 20%.
  • In Iowa, Medica — the last ACA insurer standing — says it would raise its premiums another 12% to 20% for next year if the payments end, per the Des Moines Register.
  • About 5.9 million people get the subsidies — about 57% of everyone who's enrolled in ACA private insurance coverage, according to the Centers for Medicare and Medicaid Services.
  • They're heavily concentrated in red states, and especially in the south, as you can see from this map by our visuals editor, Lazaro Gamio. (We ran this map back in April, and now that the payments are under threat again, we thought it was time for an encore.)
  • The move would end up costing the federal government more money, rather than saving money, because the ACA tax credits would adjust to cover the higher premiums. The Kaiser Family Foundation predicts a net increase of $2.3 billion in federal costs next year.
  • But anyone who doesn't qualify for the tax credits would have to eat the extra costs.
  • The White House will point out, correctly, that Congress didn't fund the payments and that it could end the uncertainty at any time by doing so.
  • Now that the repeal bill — which would have funded the payments for two years — has collapsed, most Republicans won't want to provide the funding on its own. But some are reluctantly acknowledging they may have no choice. "I think we're going to have to do that," Senate Finance Committee chairman Orrin Hatch told Reuters.

Go deeper

Storms pummel flood-hit Pacific Northwest as border river overflows

An image of the water-logged Sumas Prairie area taken last Friday. Photo: B.C. Ministry of Transportation/Twitter.

The latest ferocious storm system to hit the Pacific Northwest triggered fresh evacuation orders and at least one mudslide in flood-ravaged British Columbia, Canada, late Sunday.

Threat level: Flood sirens sounded in Washington state as the Nooksack River overflowed. Henry Braun, mayor of Abbotsford, B.C., told reporters the water flow was headed toward the Canadian border city later Sunday. "There's nothing to stop it," he said.

Updated 4 hours ago - Health

First North American Omicron cases identified in Canada

COVID-19 testing personnel at Toronto Pearson International Airport in September. Photo: Steve Russell/Toronto Star via Getty Images

The first two cases of the new Omicron variant have been detected in North America, the Canadian government announced Sunday evening.

Driving the news: The World Health Organization has named Omicron a "variant of concern," but cautioned earlier on Sunday that it is not yet clear whether it's more transmissible than other strains of COVID-19.

Former Defense Secretary Esper sues Pentagon over book

Former President Trump and former Defense Secretary Mark Esper at the White House in 2020. Photo: Mandel Ngan/AFP via Getty Images

Former Defense Secretary Mark Esper filed a lawsuit Sunday against the Defense Department, accusing the Pentagon of "censoring" his First Amendment rights by redacting aspects of his upcoming book on the Trump administration.

The big picture: Esper, who served as defense secretary from July 2019 until he was fired by then-President Trump in November last year, alleges in the suit that "significant text" is "being improperly withheld from publication" of the manuscript "under the guise of classification."