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Lazaro Gamio / Axios

Senate HELP Committee chairman Lamar Alexander will pay a lot of attention to what’s happening in his home state of Tennessee when he moves ahead on an Affordable Care Act stabilization bill. Here’s what he’s likely to hear from Tennessee insurance commissioner Julie McPeak, who’s scheduled to testify at one of the hearings on the bill next week.

The bottom line: McPeak tells me she wants help for insurers and more flexibility for the states to regulate insurance, but the first is a more urgent priority than the second. And even though Tennessee didn’t end up with any “bare counties" with no health insurance options next year, she says the state isn’t anywhere near out of danger, since only 17 counties out of 95 will have more than one insurer.

Here’s what McPeak says it would take to stabilize the markets:

  • She says Congress should fund the ACA’s cost-sharing reduction payments to insurers for another year, which is part of Alexander’s plan.
  • She also wants a reinsurance or high-risk pool program to help relieve insurers of the costs of the sickest patients — which may be off the table for this proposal, as Caitlin Owens reported last week.
  • State flexibility is important, but McPeak says it might be better to create a different kind of state waiver than the ACA’s “Section 1332” waivers, since those have to be approved by state legislatures. That’s a problem, she said, when they’re not in session for the rest of the year.
  • In the long term, she said, Congress should look at the sustainability of the ACA — “but I think that’s a lot for Congress to take on right now."

The big picture: Nationally, 1,476 counties — with roughly 2.6 million ACA marketplace customers — could have only one insurer next year, according to a map released by the Centers for Medicare and Medicaid Services yesterday.

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 5 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."

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