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Reporting from Washington — As they wrestle with how to replace the Affordable Care Act, Senate Republicans face a critical choice between cutting taxes or preserving health coverage for millions of Americans, two competing demands that may yet derail the GOP push to roll back the 2010 healthcare law.

House Republicans, who passed their own Obamacare repeal measure this month, skirted the dilemma by cutting both taxes and coverage.

Their bill — embraced by President Trump — slashed hundreds of billions of dollars in taxes, a key goal of GOP leaders and the White House as they seek to set the stage for a larger tax overhaul later this year.

At the same time, the House legislation cut more than $1 trillion in healthcare assistance to low- and moderate-income Americans, a retrenchment the nonpartisan Congressional Budget Office estimates would nearly double the ranks of the uninsured over the next decade to more than 50 million.

In the Senate, coverage losses on that scale are worrisome to many rank-and-file Republicans whose states have seen major coverage gains under Obamacare. That makes the preservation of benefits one of the biggest challenges confronting Senate Majority Leader Mitch McConnell (R-Ky.) and other GOP leaders.

“Coverage matters,” Sen. Bill Cassidy (R-La.) said last week on MSNBC’s “Morning Joe” program, noting the importance of preserving Medicaid spending in the current law. “To someone [who] is lower-income, you’re going to need those dollars to cover that person.”

Yet moderating cuts to Medicaid and other government health programs without driving up budget deficits could force Republican senators to also dial back the tax cuts that many in the GOP want.

“It’s not that complicated. … If you want to use money for tax reform, you can’t have it for health coverage,” said Gail Wilensky, a veteran Republican health policy expert who ran the Medicare and Medicaid programs under President George H.W. Bush. “You can’t do both.”

McConnell convened a group of GOP senators — quickly panned for including only white men — to develop Obamacare replacement legislation, though the panel largely excluded Republican lawmakers who are most concerned about coverage, including Cassidy. McConnell has since said that all Senate Republicans would be involved in developing an Obamacare replacement.

The trade-off between cutting taxes and preserving Americans’ health protections reflects, in part, the legislative procedure that congressional Republicans have chosen to repeal the Affordable Care Act.

That process, known as budget reconciliation, allows Senate Republicans to pass their Obamacare repeal with a simple majority, rather than the 60-vote super-majority that is usually required to pass controversial legislation. (Republicans have only a 52-48 majority in the Senate.)

But to qualify for budget reconciliation under Senate rules, the bill must reduce the federal deficit over the next decade.

Tax cuts alone typically do the opposite, driving up budget deficits.

The tax cuts in the House Republican healthcare bill total more than $600 billion over the next decade, according to independent analyses by the Congressional Budget Office and the congressional Joint Committee on Taxation.

They include most of the major taxes enacted in the 2010 health law to fund the law’s program for extending health insurance to more than 20 million previously uninsured Americans.

On the chopping block are taxes on medical device makers and health insurance plans, which together account for about $165 billion in tax cuts over the next decade.

Couples making more than $250,000 a year (and single taxpayers making more than $200,000) would see two tax cuts, including one on investment income, that the budget office estimated would cost the federal government nearly $300 billion over the next decade. (That estimate may be revised down as House Republicans delayed one of the tax cuts in the final version of their bill.)

Also eliminated would be a host of limits on tax-free spending accounts that many Americans use for medical expenses. Republicans argue these taxes are unnecessary and even undermine efforts to control healthcare costs.

“It’s bad for economic growth,” House Speaker Paul D. Ryan (R-Wis.) told Fox News during the House debate.

The tax on health plans, for example, is widely seen as contributing to higher premiums, as insurers customarily pass the costs along to consumers.

But eliminating so many taxes isn’t cheap.

So the Republican healthcare bill — known as the American Health Care Act — slashes hundreds of billions of dollars in federal healthcare spending, including an estimated $880 billion in federal money for Medicaid, the state-run government health plan for the poor that currently covers more than 70 million Americans at any one time.

That would in effect cut federal Medicaid spending by more than a quarter over the next decade, an unprecedented reduction that independent analyses suggest would force states to sharply limit coverage for poor patients.

The House bill would also reduce insurance subsidies now available to low- and moderate-income Americans who get health plans through Obamacare marketplaces such as HealthCare.gov.

The reduction in federal aid would, in turn, dramatically increase the number of uninsured Americans. Overall, the Congressional Budget Office has estimated that 24 million fewer people would have health coverage by 2026 under the original version of the House bill.

By contrast, the wealthiest Americans stand to get a large tax break. By 2023, families making more than $1 million would see their taxes decrease by an average of more than $50,000, an analysis by the independent Urban-Brookings Tax Policy Center suggests.

That means that in a country of more than 300 million people, nearly half of all the tax breaks in the House healthcare bill would go to only about 780,000 households.

The combination of tax breaks for wealthy Americans and historic reductions in assistance to low-income patients has fueled widespread criticism of the House GOP healthcare legislation, particularly on the left.

“The math is pretty clear,” said Edwin Park, vice president for health policy at the liberal Center on Budget and Policy Priorities. “They are sharply cutting Medicaid and insurance subsidies to pay for tax cuts.”

Whether GOP senators will be able to moderate the reductions in healthcare assistance remains unclear.

The early version of the House bill was projected to reduce the federal deficit by about $150 billion over the next decade, according to the Congressional Budget Office analysis.

That number has likely shrunk slightly, as House Republicans added more spending to the legislation before it passed last week. An updated budget analysis is expected next week.

But under the budget rules adopted by GOP lawmakers this year, Senate Republicans will not be able to add any spending into their legislation without enacting cuts elsewhere or shrinking the tax cuts further.

That is because according to those rules, their bill must reduce the deficit by as least as much as the House bill.

Obamacare vs. Trumpcare: A side-by-side comparison of the Affordable Care Act and the GOP’s replacement plan »

Obamacare 101: A primer on key issues in the debate over repealing and replacing the Affordable Care Act. »

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With the longest U.S. government shutdown over, state officials said Thursday that they are working quickly to get full SNAP food benefits to millions of people, though it could still take up to a week for some to receive their delayed aid.

A back-and-forth series of court rulings and shifting policies from President Trump’s administration has led to a patchwork distribution of November benefits under the Supplemental Nutrition Assistance Program. While some states had already issued full SNAP benefits, about two-thirds of states had issued only partial benefits or none at all before the government shutdown ended late Wednesday, according to an Associated Press tally.

The federal food program serves about 42 million people, or about 1 in 8 Americans, in lower-income households. They receive an average of about $190 monthly per person, though that doesn’t necessarily cover the full cost of groceries for a regular month.

A spokesperson for the U.S. Department of Agriculture, which runs the program, said in an email Wednesday that funds could be available “upon the government reopening, within 24 hours for most states.” But the agency didn’t say whether that timeline indicates when the money will be available to states or when it could be loaded onto the electronic cards used by beneficiaries.

West Virginia, which hadn’t issued SNAP benefits, should have full November benefits for all recipients by Friday, Gov. Patrick Morrisey said Thursday.

The Illinois Department of Human Services, which previously issued partial November benefits, said Thursday that it is “working to restore full SNAP benefits.” But it won’t happen instantly.

“We anticipate that the remaining benefit payments will be made over several days, starting tomorrow,” the department said in a statement, and that “all SNAP recipients will receive their full November benefits by November 20th.”

Colorado officials said late Wednesday that they are switching from delivering partial to full SNAP benefits, which could be loaded onto electronic cards starting as soon as Thursday.

Missouri’s Department of Social Services, which issued partial SNAP payments Tuesday, said Thursday that it is waiting for USDA guidance on how to issue the remaining November SNAP benefits but would move quickly once that guidance is received.

Paused SNAP payments stirred stress for some families

The delayed SNAP payments posed a new complication for Lee Harris’ family since his spouse was laid off a few months ago.

Harris, 34, said his North Little Rock, Ark., family got help from his temple and received food left by someone who was moving. With that assistance — and the knowledge that other families have greater needs — they skipped stopping by the food pantry they have sometimes used.

Harris’ family, including his three daughters, hasbeen able to keep meals fairly close to normal despite missing a SNAP payment this week. But they have still experienced stress and uncertainty.

“Not knowing a definite end,” Harris said, “I don’t know how much I need to stretch what I have in our pantry.”

Federal legislation funds SNAP for a year

The USDA told states Oct. 24 that it would not fund SNAP benefits for November amid the government shutdown. Many Democratic-led states sued to have the funding restored.

After judges ruled the Trump administration must tap into reserves to fund SNAP, the administration said it would fund up to 65% of its regular allocations. When a judge subsequently ordered full benefits, some states scrambled to quickly load SNAP benefits onto participants’ cards during a one-day window before the Supreme Court put that order on hold Friday.

Meanwhile, other states went forward with partial benefits, and still others issued nothing while waiting for further USDA guidance on the situation.

Amid the uncertainty over federal SNAP funding, some states tapped into their own funds to provide direct aid to SNAP recipients or additional money for nonprofit food banks.

The legislation to reopen the U.S. government provides full SNAP benefits not only for November but also for the remainder of the federal fiscal year, which runs through next September. Citing that legislation, the Justice Department on Thursday dropped its request for the Supreme Court to continue blocking a judicial order to pay full SNAP benefits.

Mulvihill and Lieb write for the Associated Press. AP writers John O’Connor in Springfield, Ill.; John Raby in Charleston, W.Va.; and Colleen Slevin in Denver contributed to this report.

Ukraine says European allies can give up some of their Patriot missile systems now and get future deliveries.

Most regions of Ukraine are undergoing scheduled power outages amid a new wave of attacks on energy sites by Russian drones and missiles.

Ukrenergo, the state-run electricity transmission systems operator in Ukraine, said the blackouts will last at least until the end of Monday as repairs are conducted on infrastructure damaged over the weekend and demand remains high as the onset of winter approaches.

The Poltava and Kharkiv regions are suffering from a deficit of high-voltage capacity after damage to their power transmission lines while the areas of Dnipropetrovsk, Zaporizhia, Kyiv and other central and northern regions have been affected as well.

According to Ukraine’s military, Russian forces used two air-launched ballistic missiles, five surface-to-air guided missiles and 67 drones, including those of Iranian design, during their attacks overnight into Monday.

The Ukrainian army did not report shooting down any of the missiles, but it said 52 of the drones were intercepted and the remaining 15 conducted strikes on nine locations.

Russia has maintained its attacks on Ukrainian energy infrastructure as United States-led diplomatic efforts to end the war make little progress. Ukraine has also been hitting Russian oil and fuel infrastructure in a stated effort to disrupt resources going to the front lines.

An explosion rocked Russia’s port town of Tuapse on the Black Sea overnight after Ukrainian forces launched sea drones towards the major oil terminal and refinery in the town. No casualties were reported.

Russia’s Ministry of Defence announced on Monday that four naval drones were destroyed near the port in the northeastern Black Sea.

It added that its air defences shot down six US-made HIMARS rockets and 124 fixed-wing unmanned aerial vehicles.

Ukraine wants Patriots from Europe

While calling for tougher sanctions and asset freezes to punish Russia, Ukraine is also looking to buy more arms.

President Volodymyr Zelenskyy said on Monday that Ukraine would like to order 25 Patriot air defence systems from US weapons makers as it tries to fend off Russian attacks at the brink of winter.

Zelenskyy acknowledged that the missile systems are expensive and such a large order could take years to manufacture. But he suggested that European countries could give their Patriots to Ukraine and await replacements, stressing that “we would not like to wait.”

Ukraine is also advancing with an internal drive with a stated aim of weeding out corruption in the energy sector.

The National Anti-Corruption Bureau announced on Monday that it was conducting searches in cooperation with a specialised anticorruption judicial office in premises connected to Tymur Mindich, a former business partner of the president.

Mindich, who reportedly fled before the searches, is coowner of Zelenskyy’s Kvartal 95 production company. The Anti-Corruption Bureau said the searches are in relation to a “high-level criminal organisation in the energy and defence sectors” that engaged in money laundering and illegal enrichment.

Climate-related disasters and conflict have displaced millions of people across the globe, the United Nations has warned before the opening of its annual climate change conference.

The UN’s High Commissioner for Refugees (UNHCR) said in a report, published on Monday to coincide with the launch of the 30th annual UN Climate Change conference (COP) in Brazil, that weather-related disasters caused about 250 million people to flee their homes over the past decade.

The migration agency issued its second major report on the effect of climate change on refugees – No Escape II: The Way Forward – in the run-up to COP 30, as it appears that the enthusiasm of countries to agree action to curb climate change continues to ebb.

“Over the past decade, weather-related disasters have caused some 250 million internal displacements – equivalent to over 67,000 displacements per day,” the report said. 

The UNHCR added that climate change is also increasing the difficulties faced by those displaced by conflict and other driving forces.

“Climate change is compounding and multiplying the challenges faced by those who have already been displaced, as well as their hosts, particularly in fragile and conflict-affected settings,” it continued.

Floods in South Sudan and Brazil, record heat in Kenya and Pakistan, and water shortages in Chad and Ethiopia are among the disasters noted in the report.

The number of countries facing extreme exposure to climate-related hazards is projected to rise from three to 65 by 2040.

Those 65 countries host more than 45 percent of all people currently displaced by conflict, it added.

“Extreme weather is … destroying homes and livelihoods, and forcing families – many who have already fled violence – to flee once more,” UN refugees chief Filippo Grandi said in a statement.

“These are people who have already endured immense loss, and now they face the same hardships and devastation again. They are among the hardest hit by severe droughts, deadly floods and record-breaking heatwaves, yet they have the fewest resources to recover,” he said.

By 2050, the report reads, the hottest 15 refugee camps in the world – in The Gambia, Eritrea, Ethiopia, Senegal and Mali – are projected to experience nearly 200 days of hazardous heat stress per year.

Weakening commitment

The refugee agency’s report emphasised that while the effect of climate change is growing, the commitment towards dealing with it has been weakening.

The UNHCR hopes to reawaken efforts to fight the effects at the conference in Brazil.

Under President Donald Trump, the United States, traditionally the world’s top donor, has slashed foreign aid.

Washington previously accounted for more than 40 percent of the UNHCR’s budget. Other major donor countries have also been tightening their belts.

“Funding cuts are severely limiting our ability to protect refugees and displaced families from the effects of extreme weather,” Grandi said.

“To prevent further displacement, climate financing needs to reach the communities already living on the edge,” he said. “This COP must deliver real action, not empty promises.”

About 50,000 participants from more than 190 countries will meet in Belem, in the Amazon rainforest, to discuss curbing the climate crisis.

One topic on the agenda exposing the difficulties of agreeing on global action is the European Union’s Carbon Border Adjustment Mechanism (CBAM).

The policy is designed to prevent “carbon leakage” by requiring importers of carbon-intensive goods like steel and cement to pay the same price for embedded emissions that EU producers face domestically.

While the EU promotes CBAM as a necessary environmental tool to encourage greener practices, critics of the policy, including major trading partners like the US and China, view it as a veiled act of protectionism.

Developing nations, meanwhile, are concerned that it unfairly shifts the financial burden of climate action onto them.

The US government shutdown has now lasted for 36 days, making it the longest on record. Some welfare payments, including those that allow low-income families to buy food, have been halted. The shutdown means more than a million government employees are not being paid.