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How Donald Trump Is Driving Up Health Insurance Premiums

Of that, just 8 percentage points will result from medical inflation, and 2 percentage points will stem from the reinstatement of an Obamacare health insurance tax; the balance will be related to the uncertainty that Mr. Trump has created around key pieces of Obamacare.


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The largest portion of the total — about 15 percentage points — is connected to the potential demise of the cost-sharing reductions (known as C.S.R.s), payments made by the government to insurers to help cover out-of-pocket costs like co-pays and deductibles that lower-income Americans can’t afford.

(The Congressional Budget Office said on Tuesday that premiums for the most popular health insurance plans would rise by 20 percent next year, and federal budget deficits would increase by $194 billion in the coming decade, if Mr. Trump ends the subsidies.)

Those subsidies, which were created by the Obama health care legislation and which benefit seven million Americans, have been in limbo since House Republicans sued in 2014, contending that they needed to be appropriated by Congress, which wasn’t going to happen as long as Republicans controlled each chamber.

How Cost-Sharing Subsidies Reduce Deductibles …

Figures for silver plans.

… And Out-of-Pocket Costs


Conservatives won the first round in court, but that decision was stayed pending appeal, allowing both the Obama and Trump administrations to continue to make the monthly payments.

President Trump has threatened to end the subsidies but has yet to take definitive action. A decision was promised by Aug. 4, but Mr. Trump decamped to his New Jersey golf resort with nary a word about C.S.R.s.

As a result, many of the insurance companies that have already announced their increases have either baked in increases assuming loss of the subsidies or say that they will impose further hikes if the subsidies are not continued.

The silence around the C.S.R.s is consistent with the new administration’s overall approach to the A.C.A.: continually badmouthing it and taking small steps to undermine it without unleashing a full-force assault.

Even without “repeal and replace” legislation emerging from Congress — an unlikely event at this point — the administration has enormous authority to shape the functioning of the A.C.A.


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As Tom Price, the secretary of health and human services, has said repeatedly, there are 1,442 places in the existing law that provide him with some measure of discretion in how the act is implemented.

For example, the Internal Revenue Service said this year that it would start accepting tax returns even if the filer has not confirmed having insurance or submitting the penalty.

Around the same time, the new team pulled advertising designed to encourage enrollments, causing sign-ups for 2017 to fall modestly short of expectations, especially among younger and healthier Americans, who are much more likely to wait until the last minute to enroll.

More recently, the administration canceled contracts with two companies that helped Americans in 18 cities find plans.

All of these actions — and more — could amount to undermining the individual mandate, a step that Mr. Gaba says would add another 4 percentage points to 2018 premium increases.

Trump Policies Raising Health Premiums

Breakdown of reasons for 2018 rate hike requests.

At the same time, some steps toward preparing for the next enrollment period are proceeding normally, such as an annual meeting in June with “navigators” who guide consumers in their choices of plans.

In addition, the Trump team has been allocating funds to states with weak exchange markets to encourage insurers to continue to provide coverage.

But what else the administration will or won’t do as the November opening of the enrollment period approaches remains a mystery.


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Asked last week by The Washington Post to clarify, a spokeswoman for the Centers for Medicare and Medicaid Services would say only, “As open enrollment approaches, we are evaluating how to best serve the American people who access coverage on”

An hour later, the spokeswoman, Jane Norris, tried to withdraw the statement and refused to comment further. Ms. Norris’s office did not respond at all to my inquiry.

A bipartisan group of senators is trying to draft legislation to stabilize Obamacare. But with Congress gone, any new laws will come too late for the Sept. 5 deadline for setting 2018 premiums.

So it well may be up to Mr. Trump to decide, in effect, the fate of the exchanges, which supply about 12 million Americans with their coverage. With final premium increase decisions due soon, even inaction could be devastating.

As the president has acknowledged on occasion and as public opinion polls confirm, the failure of Congress to pass any legislation means that the new administration “owns” the health care issue politically. Continuing to let it flounder in the twilight zone will be damaging not only to Mr. Trump’s political health but more important, to the health of millions of Americans who deserve better.

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Charlottesville, hate crimes are public health issue, experts say

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Trump shows he hasn’t forgotten McCain’s health care vote

Think North Korea and Charlottesville have made President Trump forget about that “no” vote Sen. John McCain cast July 28 on the ObamaCare “skinny repeal” amendment?

Think again.

From all indications at Trump’s Tuesday press conference at Trump Tower in New York City, the Arizona Republican’s vote remains very much on the president’s mind.

In fact, it came up when a reporter asked Trump about McCain’s defense of H.R. McMaster, the national security adviser who has been targeted with criticism from alt-right activists, the Arizona Republic reported.

“Senator McCain? You mean the one who voted against ObamaCare?” the president responded. “You mean Senator McCain who voted against us getting good health care?”

Trump even brought up McCain’s name a second time, the newspaper reported, when the president was asked if his infrastructure plan would advance — unlike stalled agenda items such as health care reform.

“We came very close with health care,” the president said. “Unfortunately, John McCain decided to vote against it at the last minute. You’ll have to ask John McCain why he did that. But we came very close to health care. We will end up getting health care, but we’ll get the infrastructure. And actually, infrastructure is something that I think we’ll have bipartisan support on.”

“We came very close with health care. Unfortunately, John McCain decided to vote against it at the last minute.”

- President Donald Trump

McCain had urged Trump to defend McMaster from alt-right criticism, the Republic noted.

“Since this fringe movement cannot attract the support of decent Americans, it resorts to impugning the character of a good man and outstanding soldier who has served honorably in uniform and sacrificed more for our country than any of his detractors ever have,” McCain said in a statement. “Such smear tactics should not be tolerated and deserve an emphatic response. I hope the president will once again stand up for his national security adviser and denounce these repugnant attacks.”

Trump and McCain have been at odds since at least June 2015, when McCain said he didn’t approve of Trump’s comments about Mexicans when Trump launched his presidential campaign.

That sparked some back-and-forth between the two men, including Trump’s notorious “I like people that weren’t captured” remark the following month, referring to McCain, a former prisoner of war.

Following Trump’s Tuesday press conference, McCain issued a tweet, criticizing Trump for not more forcefully distinguishing between the groups that participated in the Charlottesville rally over the weekend.

“There’s no moral equivalency between racists Americans standing up to defy hate bigotry,” McCain tweeted. “The President of the United States should say so.”

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GOP Doomed Its Own Health Care Proposals With ‘Politics of Destruction’

On July 28 in the wee hours of the morning, the seven-year battle by Republicans to repeal and replace Obamacare ended with a whimper when three Republican senators defected to vote against a so-called “skinny bill.” Many pundits attributed the failure of “repeal and replace” to the lack of presidential leadership and to divisions between moderates and conservatives. Sure, those issues mattered, but what led to the Republicans’ downfall was their failure to recognize how much the winds had shifted.

Obamacare had poured money into Medicaid, the federal-state program of health insurance for poor and low-income people, and mandated that all states expand the program. Despite a 2012 Supreme Court ruling that made the Medicaid expansion optional, by 2017, 32 states had expanded Medicaid to cover new groups and add new benefits. Most of those states were led by Democrats, but a substantial minority by Republicans. When both the House and Senate proposed huge cuts to Medicaid, governors from both parties denounced the plans at their annual summer meeting. Republican Governor Brian Sandoval of Nevada, an expansion state, summed up many of his colleagues’ views, declaring that he had “great concerns” and that he would oppose any bill that cut Nevada’s Medicaid program. That should have given pause to the 20 Republican senators who came from the Medicaid expansion states, but they heedlessly plunged ahead.

The public had also changed its tune. Although Medicaid had started as a program of welfare medicine, over time it had expanded well into the middle class. A 2011 poll found that 85 percent of respondents opposed cuts to Medicaid. Medicaid had become as popular as social security and Medicare.

Politicians aren’t the only ones who have a stake in Obamacare. So do numerous organizations that govern the delivery of medical services and that arrange for the financing of care. All these organizations are alert to any proposed change to the health care system and thus make up a cadre of potential resistance.

Mitch McConnell Senate Majority Leader Mitch McConnell speaks with reporters on Capitol Hill on July 25. Three Republicans crossed party lines to join Democrats in a 49-51 vote to kill the health care bill. REUTERS/Aaron P. Bernstein

The first to speak out were the provider groups. On March 8, the American Hospital Association sent a letter to the House of Representatives slamming the proposed Medicaid cuts, which would make “significant reductions in a program that provides services to our most vulnerable populations.” The following month, the American Medical Association released a similar letter, urging House members to vote against their own bill so that millions of Americans would not lose their insurance. Especially offensive to the AMA were plans to eliminate regulations that allow adult children to stay on their parents’ policies until age 26 and that ban insurance companies from denying coverage due to pre-existing conditions.

The Senate fared no better. When Republican senators proposed their first plan, the Better Care Act, AARP, the largest voluntary organization in the U.S., led the charge. In an open letter, the AARP slammed the Senate bill, labeling it “Wealthcare” and condemning “the Age Tax that would allow insurance companies to charge older Americans five times more for coverage than everyone else.” AARP also opposed the deep cuts to Medicaid, which would “strip health care from millions of low-income and vulnerable Americans,” and the cuts to Medicare, “which weakens the program.”

In July, the insurance industry, which had largely remained on the sidelines, weighed in. The CEOs of America’s Health Insurance Plans and the Blue Cross/Blue Shield Association blasted the Freedom Option, a new provision which would allow insurance companies to sell cheaper policies in the state exchanges without the popular mandated Obamacare benefits like maternity care.

Republicans also failed to deliver a message that resonated with the public. The mantra of opposition to “big government” was first adopted in 2009, when a Republican strategist urged Republicans to call Obamacare a “government takeover.” That phrase was repeated each time House Republicans voted for repeal. The problem was that by 2017, people who had initially believed that Obamacare represented a government takeover or, worse, socialized medicine, had now witnessed the benefits for themselves and their families. Indeed, a June CNN poll reported that 51 percent of the public had a favorable view of Obamacare, while only 17 percent approved of the Better Care Act.

That shift in public opinion left Republicans without a coherent message for rallying support to repeal. Robbed of their big government bluff, Republicans could only lambast Obamacare for reasons the public no longer believed. Meanwhile, Democrats drew upon an alternative message, defining Republicans’ health care plans as divisive and un-American. When House Speaker Paul Ryan praised the House bill as “an act of mercy,” Rep. Joe Kennedy (D-Mass.) fired back: “With all due respect to our speaker, he and I must have read different Scripture. The one that I read calls on us to feed the hungry, to clothe the naked, to shelter the homeless and to comfort the sick. It reminds us that we are judged not by how we treat the powerful, but by how we care for the least among us.” 

Other Democrats charged that “Trumpcare” would strip insurance from tens of millions of Americans to fund a tax cut for the wealthy. Senator Chris Murphy (D-Conn.) declared that “sick and older people will see costs skyrocket. Protections for people with pre-existing conditions will be gutted with insurance companies put back in charge.” Former President Obama, too, chimed in with an uplifting message: “This debate has always been about something bigger than politics. It’s about the character of our country—who we are and who we aspire to be.”

The legacy of Medicaid, the opposition of interest groups and the lack of a coherent reason for repealing Obamacare ensured that Republicans would fail. Instead of engaging in the politics of destruction, Republican should work with Democrats to repair problems in the private insurance market and to actually serve the public that elected them.

Jill Quadagno is the Mildred and Claude Pepper Eminent Scholar Emeritus at the Pepper Institute on Aging and Public Policy at Florida State University. She is the author of One Nation, Uninsured: Why the U.S. Has No National Health Insurance. Daniel Lanford, a postdoctoral fellow at the Scholars Strategy Network, also contributed to this article.

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Study: Moderate Drinking May Offer Some Protective Health Benefits

PHILADELPHIA (CBS)—A new study reveals that moderate alcohol consumption may just be good for you.

The new study released in the Journal of the American College of Cardiology says light to moderate alcohol consumption may offer some protective health benefits.

“At light to moderate doses of alcohol there was a decrease in both all-cause mortality or death, and a decrease in cardiovascular mortality or death. And at high doses of alcohol, there was increase in mortality and an increase in cancer deaths,” said Dr. Tara Narula, cardiologist at Northwell Health.

Drinking Beer May Lead To Mental Clarity, Study Says

Moderate alcohol use in this study was –less than 14 drinks a week for men and seven for women.

It was associated with a 25 percent lower risk of overall death.

“One of the theories is that alcohol may raise the HDL or good cholesterol, it may help to improve the health of the blood vessels, decrease clotting or break up the blood clots, improve inflammation, lower it and have antioxidant benefits,” said Narula.

The researchers said the cardiovascular benefits of alcohol were most helpful for older adults, but younger drinkers also noted other benefits.

Coffee Recalled For Undeclared Viagra-Like Ingredient

Researchers looked at data on more than 330,000 people over more than 10 years for this study. It didn’t focus on the type of alcohol consumed, but many doctors think red wine is best.

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Drink to your health? It depends on how much drinking you do, study shows

This just in, and it’s definitive (for now): People who drink alcohol in moderation — especially older people, women and non-Latino white people — are less likely to die of any cause than are teetotalers or people who consume heavy doses of alcohol either on occasion or in an average week.

In follow-up periods that hovered around eight years, moderate drinkers were no less likely than alcohol abstainers to die of cancer. But they were roughly a quarter less likely to die of heart disease or stroke than were people who never consumed alcohol.

Heavy drinkers fared slightly worse than moderate drinkers and never-drinkers in their likelihood of dying of any cause during the studies’ follow-up periods. But it wasn’t the risk of heart failure or heart attack that heavy drinkers drove up: it was cancer.

Heavy drinkers’ odds of dying from cancer were roughly 45% higher than were the cancer-death odds of moderate drinkers.

Health insurers seek higher rates for Minnesota small businesses

Small business health plans in Minnesota could be facing double-digit premium increases next year, with some insurers saying that enrollees are consuming more care just as medical costs are rising.

The number of those potentially affected by proposed increases is about 160,000.

Preliminary figures released this month are rekindling fears that some small businesses might drop group coverage altogether, but such moves could be tough in a tight labor market where employers use health benefits to compete for talent.

The state’s four largest health insurers for small businesses are proposing average increases that range from 8 to 17 percent, a slightly higher range than 2017 rate proposals that resulted in an overall average increase of nearly 10 percent after reviews by regulators. The state Commerce Department is scheduled to release final rates by Oct. 2.

“The mountain is harder to climb every year,” said Kevin Otto, chief financial officer at Otto Transfer, a trucking business in Delano that has maintained its employee health plan despite the cost pressures.

In Minnesota, employers with two to 50 workers are covered through the “small group” market, which this year includes more than 275,000 enrollees, according to data released this month by the federal government.

The largest health insurer in the small group market is Bloomington-based HealthPartners, with about 130,000 members. The insurer is seeking an average increase of 17 percent for most of those enrollees.

In a regulatory filing, HealthPartners said it lost money on the small group business in 2016 due in part to higher than expected medical claims. In 2018, the insurer projects increased use of medical services, plus higher payment rates to health care providers and for prescription drugs.

“We expect to see continuing small losses in 2017,” the company said in the filing. “The requested rate increase is projected to result in revenue that is adequate to cover claims and expenses in 2018.”

Golden Valley-based PreferredOne is seeking an average rate increase of nearly 12 percent for about 30,000 enrollees. In its filing, PreferredOne said: “The biggest driver of the rate change is the increasing illness level of policy­holders.”

Eagan-based Blue Cross and Blue Shield of Minnesota, which is the second-largest carrier in the market, is seeking an average increase of 9 percent for most of the 89,000 enrollees it currently covers in the small group market. Blue Cross also cited medical cost and utilization trends, adding that reinstatement of a federal tax on health insurers next year also justifies the rate increase.

Not all carriers, however, stressed the same factors in their filings. Minnetonka-based Medica, for example, did not call out higher cost and utilization trends when explaining its proposed average increase of about 8 percent for most of its 29,000 small group customers.

“The rate increases look to be for different reasons based on which insurer you’re looking at,” said Jim Schowalter, chief executive of the Minnesota Council of Health Plans, a trade group for insurers. “A lot of work still needs to be done.”

Overall, the requested premium increases are “very alarming,” said Mike Hickey, Minnesota state director for the National Federation of Independent Business.

“They’re serving up pretty large increases — way beyond nominal, way higher than health insurance inflation and very concerning,” Hickey said.

When the federal Affordable Care Act (ACA) in 2014 changed rules for how insurance companies set premiums in the small group market, some employers saw premium spikes of up to 40 percent, Hickey said. The rule change meant that health plans could no longer give premium breaks to healthier groups, or impose financial penalties on groups that used more health care.

While premiums aren’t poised to rise by such a large margin, the numbers are big enough that employers likely would shop around for new options, said Bentley Graves of the Minnesota Chamber of Commerce. Some might drop coverage altogether.

In January, the Legislature made it easier for small groups to “self-insure,” meaning the employer takes the risk for medical claims in conjunction with a stop-loss insurer, Graves said. In exchange, employers can save money on health plan costs. Changes in state and federal law will make it possible in 2018 for small employers to help pay individual market premiums on a pretax basis.

Both changes are meant to give small employers options for providing coverage. The number of groups in the small group market has been inching up in the past year, Graves said, but the tally dropped significantly from 2013 to 2015.

“There was plenty of reason to leave the small group market in the first couple of years [after the ACA] as small group rates increased for some … and, at the same time, we had some of the lowest individual market rates in the country,” Graves said. “Now, although small group rates have certainly continued to increase, they’ve increased much more slowly than individual market rates.”

Going forward, if regulators approve the proposed premium increases, small businesses will consider a variety of benefit changes to save money, said Greg Dattilo, a benefits consultant and owner of Dattilo Consulting in Chanhassen. Options include tighter limits on the health plan’s network of doctors and hospitals, and higher premium splits and deductibles.

But Dattilo said he didn’t expect employers would drop their health plans, saying he’s hearing from small firms that are thinking of starting a health plan for the first time in order to better compete for workers.

“Employers are not going to drop their health insurance because they will lose their employees, especially with the millennials,” he said. “If you don’t offer medical insurance, you’re not a player.”

Otto Transfer in Delano just switched health insurers in order to moderate premium increases for 2017.

Kevin Otto said the company was one of the small employers hit with big rate increases in 2014 with the switch to new rate-setting rules under the ACA. The company added large deductibles to the health plan as a result.

Otto Transfer is a family business that dates to the 1940s and specializes in hauling power line poles on flatbed trucks. With 24 employees, most of whom participate in the company health plan, the company believes providing good benefits is part of its responsibility to workers, Otto said, but premium increases put the firm in a tough spot.

“At what point is the price break,” Otto said, “where you just throw yourself out?”


Twitter: @chrissnowbeck

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Dehydration can creep up on you and cause serious health problems

Consumer Reports has no financial relationship with any advertisers on this site.

During summer’s heat, it’s easy to become dehydrated without realizing it. And dehydration, which occurs when you lose more water via sweat and urine than you’ve taken in, can be especially dangerous for older adults.

A lack of sufficient fluid in the body can temporarily cause confusion and put you at risk for falls. When severe, dehydration can lead to a rapid or irregular heart rate, low blood pressure, fainting and even death. “How much water you have affects every body system,” says Jodi Stookey, an epidemiologist in San Francisco.

Staying well hydrated becomes more difficult with age because your sense of thirst tends to diminish with time. Diuretics, often prescribed for high blood pressure and heart failure, can exaggerate water loss. But you can protect yourself. Here’s how:

Dehydration can be challenging to detect as we age because classic signs such as dry mouth, thirst, fatigue and skin that doesn’t spring back quickly when pinched can also be caused by other factors. In fact, a 2015 review of research by the independent Cochrane Collaboration found that there was no single reliable test for dehydration.

The color of your urine can sometimes be a clue. In general, healthy urine is the shade of pale straw. The darker your urine, the less hydrated you may be. But aspirin, multivitamins and certain fruits and vegetables can also affect the shade of your urine.

If you suspect you might be dehydrated based on your urine’s color and/or the other signs mentioned, try drinking two to three full glasses of water during the course of an hour or two, advises Marvin M. Lipman, Consumer Reports’ chief medical adviser. If you still have symptoms of dehydration or don’t urinate within four hours, it’s wise to contact your doctor.

So how much — and what — should you drink? There’s really no overarching rule, and what’s appropriate can vary a good bit from person to person. Generally speaking, the heavier, taller and more active you are (and the hotter and more humid the weather is), the more fluids you need to take in to cover your losses. To make sure you get enough:

Drink before you feel parched. To make up for that reduced sense of thirst, sip preemptively. By the time you feel thirsty, you might be mildly dehydrated.

Sip small amounts throughout the day. If you find it difficult to consume a full glass of water all at once, drink a bit at a time, but frequently. Carrying a water bottle with you at all times can help remind you to drink.

Include other beverages and foods. All beverages (other than alcoholic drinks) will hydrate you, and that includes caffeinated drinks. Coffee and tea are mild diuretics, so they can cause you to urinate more. But they will add more to your liquid stores than you’ll lose, says Janet Mentes, a professor at the UCLA School of Nursing. Soup, fruits and vegetables are also good sources of liquid.

Take your health into consideration. Ask your doctor whether medical conditions you have or medications you take affect your hydration needs. And keep in mind that some health conditions, such as kidney disease and congestive heart failure, may make it dangerous to take in too much fluid. Your doctor can guide you.

Taking in too little liquid is an important factor in dehydration, but the following play a role as well:

•Infections that cause diarrhea, vomiting, excessive sweating and fever. Tara Cortes of New York University suggests calling a doctor if you vomit repeatedly or have a fever of more than 101 degrees for more than a day or diarrhea for more than two days.

•Medication that causes the kidneys to produce more urine, such as diuretics. Some over-the-counter drugs, such as laxatives, may also cause water loss.

•Health conditions, such as poorly controlled diabetes, that lead to excessive water loss. A 2016 study in the Annals of Family Medicine found that obese people were more likely than others to be inadequately hydrated. Having dementia, Parkinson’s disease or a stroke can also increase the chances of dehydration.

 Copyright 2017, Consumer Reports, Inc.

Consumer Reports is an independent, nonprofit organization that works side by side with consumers to create a fairer, safer, and healthier world. CR does not endorse products or services, and does not accept advertising. Read more at

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Health Insurers Get More Time to Calculate Increases for 2018 – The …

Mr. Trump has repeatedly threatened to cut off the payments as a way to force Democrats to negotiate over the future of the Affordable Care Act.

The president can stop the payments because a federal judge ruled last year that the Obama administration had been illegally making the payments in the absence of a law explicitly providing money for the purpose. The Obama administration appealed the ruling, and the payments continue from month to month, with permission from the court. But Mr. Trump could drop the appeal and stop the payments at any time.

In its latest bulletin, the Trump administration said that many state insurance commissioners had allowed insurers to increase rates for 2018 to account for the “uncompensated liability” that they might face for the cost-sharing reductions.

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The amount of the increases varies, but many insurers say that prices will be 15 to 20 percent higher next year because they do not know if they will receive the subsidies they are anticipating.

The future of the subsidies has been uncertain since Republican efforts to repeal major provisions of the Affordable Care Act collapsed last month in the Senate, where three Republicans joined all Democrats in voting down a proposal drafted by the majority leader, Senator Mitch McConnell of Kentucky. Mr. Trump chided Mr. McConnell for the failure and urged him to keep trying.

The impasse is already taking a toll.

“Planning and pricing for A.C.A.-compliant health plans has become increasingly difficult due to a shrinking and deteriorating individual market, as well as continual changes and uncertainty in federal operations, rules and guidance, including cost-sharing reduction subsidies,” one of the nation’s largest insurers, Anthem, said last week in explaining its decision to curtail its participation in the individual market in Nevada and Virginia.

Congress could reduce the uncertainty and stabilize insurance markets by providing money for the cost-sharing subsidies — a step supported by doctors, hospitals, insurers, consumer groups, the United States Chamber of Commerce and the influential chairmen of three congressional committees: Senator Lamar Alexander of Tennessee and Representatives Kevin Brady of Texas and Greg Walden of Oregon, all Republicans.

Some lawmakers, however, want to offset the cost of the subsidies, estimated at $7 billion to $10 billion next year, perhaps by cutting other health programs. Moreover, many Republicans criticize the subsidies as a bailout for insurers and say they will not provide the funds unless Congress also takes steps to reduce insurance costs and cut back federal regulation of the industry.

Lawmakers plan to return from their summer recess on Sept. 5, so they will not provide any definitive guidance before insurers file their rates on the same day.

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FHC to mark National Health Centers Week

On Public Housing Day on Aug. 15, FHC will select seven low-income apartment complexes in its service areas of Orangeburg, Denmark, Holly Hill, Neeses, St. Matthews, St. George and Vance, where it will distribute laundry products to the residents.

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