A major winter storm with millions of Americans in its path brought a mix of rain, freezing rain and snow to the central U.S. as airlines canceled thousands of flights, officials urged residents to stay off roads and schools closed campuses.

The blast of frigid weather, which began arriving Tuesday night and continued Wednesday, put a long stretch of states from New Mexico and Colorado to Maine under winter storm warnings and watches. On Wednesday morning, Oklahoma, Kansas, Missouri, Illinois, Indiana and Michigan saw freezing rain, sleet and snow.

By midday Wednesday, some places had already reported snow totals exceeding or nearing a foot, including the central Illinois town of Lewistown with 14.4 inches and the northeastern Missouri city of Hannibal with 11.5 inches.

“And it’s still snowing across these areas,” said Andrew Orrison, a meteorologist with the National Weather Service in College Park, Maryland.

Central Illinois and northern Indiana appeared likely to receive the most snowfall, with expected totals ranging from 12 to 18 inches by the end of Thursday, Orrison said.

Snow had begun to taper off in Missouri by early afternoon but much of the state could wind up with 8 inches to a foot of snow. Parts of Michigan also could snow totals around a foot by Thursday.

In Chicago, Elisha Waldman and his sons welcomed the opportunity to hit a sledding hill Wednesday morning, even as snow continued to fall.

“Cold and wet and wonderful, and getting cold and wet is part of the fun with the guys, and we get to go inside and have hot cocoa and warm up,” Waldman said.

In Detroit’s western suburbs, Tony Haley also found an advantage to the weather. He owns a landscaping and irrigation company that offers snow removal and salting services, but the early winter weeks offered few opportunities for business.

“This one here, we’re looking for a good two, three days of work,” Haley said after clearing snow away from several businesses in Canton.

But for those on the roads, the heavy snow created hazardous conditions.

“We’re receiving a lot of snow over here in northwest Indiana and it’s the wet, slushy snow that causes treacherous driving conditions to say the least,” Indiana State Police Sgt. Glen Fifield told WFLD-TV.

In central Missouri, officials shut down part of Interstate 70 midday after a crash made the roadway impassable.

Areas south of the heavy snow were expected to see freezing rain, with the heaviest ice predicted along the lower Ohio Valley area from Louisville, Kentucky, to Memphis, Tennessee.

“If everything holds to where it is right now, this is the real deal,” said Kentucky Gov. Andy Beshear, who ordered state government offices to close on Thursday. “It is dangerous. People need to be prepared.”

The disruptive storm moved across the central U.S. on Groundhog Day, the same day the famed groundhog Punxsutawney Phil predicted six more weeks of winter. The storm came on the heels of a nor’easter last weekend that brought blizzard conditions to many parts of the East Coast.

The storm’s path extended as far south as Texas, nearly a year after a catastrophic freeze buckled the state’s power grid in one of the worst blackouts in U.S. history. The forecast did not call for the same prolonged and frigid temperatures as the February 2021 storm, and the National Weather Service said the system would, generally, not be as bad this time for Texas.

Early Thursday morning there were over 46,000 power outages being reported in Texas and over 17,000 in Oklahoma, according to poweroutage.us.

Snowfall totals reached 22 inches in Colorado Springs and up to 10 inches in the Denver area, with more expected, prompting universities, state government offices and the Legislature to shut down.

Airlines canceled nearly 8,000 flights in the U.S. scheduled for Wednesday or Thursday, the flight-tracking service FlightAware.com showed. Airports in St. Louis, Chicago, Kansas City and Detroit canceled more flights than usual. Almost 700 flights were canceled Thursday alone at Dallas-Fort Worth International Airport, and more than 300 were canceled at nearby Dallas Love Field.

In an effort to stay ahead of the weather, Southwest Airlines announced Tuesday that it would suspend all of its flight operations Wednesday at St. Louis Lambert International Airport and Thursday at its Dallas Love Field hub.

National Weather Service forecasters in Little Rock put their own spin on the Groundhog Day tradition with a photo of their office cat, Tarmac, and the caption: “SHADOWS EVERYWHERE! THE WINTER STORM IS HAPPENING!”

Groups representing a range of mental health therapists say a new law that protects people from surprise medical bills puts providers in an ethical bind and could discourage some patients from care.

The therapists take no issue with the main aim of the legislation, which is to prevent patients from being blindsided by bills, usually for treatment received from out-of-network medical providers who work at in-network facilities.

Instead, they are concerned about another part of the law — a price transparency provision. That provision requires most licensed medical practitioners to give patients detailed upfront cost estimates, including a diagnosis, and information about the length and costs involved in a typical course of treatment. That’s unfitting for mental health care, therapists say, because diagnoses can take time and sometimes change over the course of treatment.

Finally, if they blow the estimate by at least $400, the law says uninsured or self-pay patients can challenge the bills in arbitration.

Arguing that the rule is burdensome and unnecessary, mental health providers wrote a Jan. 25 letter to the Department of Health and Human Services, seeking an exemption from the “good faith” estimates for routine mental and behavioral health services. The letter was signed by 11 groups, including the American Psychological Association, the National Association of Social Workers, the American Psychiatric Association, and the Psychotherapy Action Network.

Some also worry that the law will allow insurance companies to play a larger role in dictating what even non-network mental health therapists can charge, although policy experts say it isn’t clear how that could happen. Although exact figures are not available, it’s estimated that between one-third to one-half of psychologists are not in-network with insurers, the psychologists’ association said. And those numbers do not include other practitioners, such as psychiatrists and licensed clinical social workers, who are also out of network.

“We got thrown into this bill, but the intention [of the law] was not mental health but high-cost medical care,” said Jared Skillings, chief of professional practice with the American Psychological Association. “We’re deeply concerned that this [law] inadvertently would allow private insurance companies to set regional rates across the country that, for independent practitioners, would be a race to the bottom.”

Therapy costs vary widely around the U.S. and by specialty, but generally range from $65 an hour to $250 or more, according to the website GoodTherapy.

The good faith estimates must be given this year to uninsured or self-pay patients for medical or mental health care services. They were included in the No Surprises Act as part of a broader effort to give patients a good idea of cost, both per visit and for a course of treatment, in advance.

Therapists say their professional codes of ethics already require disclosure to patients of per-visit costs. Requiring diagnostic billing codes in the estimate before even seeing a patient — as they interpret the rule — is unethical, they argue, and tallying up what might be weeks or even months of treatment costs could keep some patients from undergoing care.

“If people see a large dollar amount, they might be intimidated or scared into not getting help at all,” said Linda Michaels, a private practice therapist in Chicago and co-chair of the Psychotherapy Action Network.

The counterargument, though, is that one of the law’s aims was to provide patients with pricing information — for mental health services or medical care — that is less opaque and more similar to what they’re used to when shopping for other types of goods or services.

Benedic Ippolito, an economist at the American Enterprise Institute, said he is sympathetic to medical providers’ concerns about the extra administrative burden. But “giving consumers a better sense of financial obligation they are exposed to and imposing some cost pressure on providers are both reasonable goals,” he said.

Even among providers, there is no universal agreement on how burdensome the estimates will be.

“It’s not an unreasonable thing, frankly, for psychiatrists, not just plastic surgeons or podiatrists, to say, ‘If you want me to do this and you’re not covered by insurance or whatever, it will cost you X amount for the whole episode of care and this is what you get in return,'” said Dr. Robert Trestman, chair of psychiatry and behavioral medicine at the Virginia Tech Carilion School of Medicine. Although he serves on an American Psychiatric Association committee, he was voicing his own opinion.

The Centers for Medicare & Medicaid Services said mental health providers are not exempt from the rules about good faith estimates, in a written statement to KHN. It added, however, that the agency is working on “technical assistance geared toward mental health providers and facilities.” Federal agencies often issue additional clarification of rules, sometimes in the form of FAQs.

The No Surprises Act took effect Jan. 1. Its thrust was to bar medical providers from sending what are called surprise or “balance” bills to insured patients for out-of-network care provided in emergencies or for nonemergency situations at in-network facilities. Common before the law passed, such bills often amounted to hundreds or thousands of dollars, representing the difference between the amount insurers paid toward out-of-network care and the often much higher amounts charged.

Now, insured patients in most cases will pay only what they would have been billed for in-network care. Any additional amount must be worked out between their insurer and the provider. Groups representing emergency doctors, anesthesiologists, air ambulance providers, and hospitals have filed lawsuits over a Biden administration rule that outlines the factors independent arbitrators should consider when deciding how much an insurer must pay the medical provider toward disputed bills.

Most mental health services, however, aren’t directly touched by this part of the directive because treatment is not typically performed in emergency situations or in-network facilities.

Instead, the complaint from mental health providers focuses on the good faith estimates.

Additional rules are expected soon that will spell out how upfront estimates will be handled for people with health coverage. In their letter to HHS, the behavioral health groups say they fear the estimates will then be used by insurers to limit treatment for insured patients, or influence pay negotiations with therapists.

Several policy experts say they do not think the law will affect mental health reimbursement in most cases.

“Mental health professionals will have the exact same ability to bill out-of-network, to have patients agree to whatever market price is for their services,” said Loren Adler, associate director of the USC-Brookings Schaeffer Initiative for Health Policy, who has long studied balance billing issues. “Nothing about the No Surprises Act restricts that.”

Some of the therapy groups’ concerns may stem from misreading the law or rules implementing it, say policy experts, but they still reflect the confusion providers share surrounding the rollout of the law.

As for how to handle pre-treatment diagnoses that are needed to deliver good faith estimates, CMS said in its email to KHN that providers could estimate costs for an initial screening, then follow up with an additional estimate after a diagnosis.

“No one is going to be forced to make a diagnosis of a patient they have not met,” Adler said.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

Former President Donald Trump has endorsed another GOP primary challenger in the upcoming midterm elections, as he tries to take down the small number of Republican House members who voted to impeach him following last year’s attack on the Capitol.

“Congressman Tom Rice of South Carolina, the coward who abandoned his constituents by caving to Nancy Pelosi and the Radical Left, and who actually voted against me on Impeachment Hoax #2, must be thrown out of office ASAP,” Trump wrote in a statement Tuesday.

But Rice is not backing down.

“If we are going to have a scenario where the president can try to intimidate Congress into doing what he wants, well shoot, we might as well have a monarchy,” Rice said in an interview from his Myrtle Beach home.

The congressman, who represents the state’s 7th District, had just returned from a chamber of commerce speaking engagement, where he was greeted by protesters angry about his impeachment vote.

Rice told those who attended the event he’s proud of his accomplishments during his five terms in office. He was recently named ranking member of the House Ways and Means Oversight Subcommittee. He says he helped Trump draft the 2017 Tax Cuts and Jobs Act and voted with the former president more than 90% of the time.

But even those who know the congressman’s voting record are upset about his vote to impeach. Immediately after, Rice was censured by the state’s Republican Party.

Still, he stands by his belief that Trump was responsible for the Capitol violence.

He vividly remembers seeing beaten, bloody police while seeking safety from the House floor. Rice says the former president should have stopped the attack instead of watching it on television in the Oval Office, surrounded by Secret Service members.

“And I guess if the consequences are that the people think what happened is OK, then I guess, you know, I’m not that guy,” Rice said.

The congressman faces a slew of challengers, including South Carolina state Rep. Russell Fry. The 37-year-old was just endorsed by Trump, who called Fry Tuesday.

“He said he’s been following our work at the Statehouse, from election integrity to the heartbeat bill to the open carry bill we passed last year,” Fry said.

Fry believes he better represents people in the 7th Congressional District because he listens to what they want — unlike Rice.

“He hasn’t done that and continued to kind of poke the voters in the eye and they’re frustrated, and I get that because I’m frustrated too,” Fry said.

Also frustrated is Jeanette Spurlock, a single mother of three who says the district doesn’t need another politician. She’s also mounting a primary challenge.

Spurlock is angry that Rice not only voted to impeach Trump, but also recently doubled down, saying he regrets not voting to certify the election for President Biden.

“My heart is just aching because I feel betrayed and a lot of people do feel betrayed,” said Spurlock, who was making campaign T-shirts in her spare bedroom.

She has no plans to drop out. She, like several others, just wants to run against Rice.

“That is one of the vulnerabilities of Tom Rice. Nobody would have thought of doing that,” said Jerry Rovner, the district’s GOP chair. “I mean, Tom could have been in that seat forever.”

Rovner believes the impeachment vote could cost Rice his job.

He expects the number of challengers to dwindle following the Trump endorsement and says an open primary, one that allows any voter to participate, may favor the congressman in the strongly Republican district.

“So, if there’s not a viable candidate on the Democratic side, he’s going to get a lot of votes because people are going to come in and vote in the primary,” Rovner said.

Rice was among 10 House Republicans who voted to impeach Trump after the Capitol riot. Three of them have announced their departure from Congress.

But Rice feels he still has support in his South Carolina district.

“I will tell you that for every person that expresses disappointment, 10 people tell me thank you,” he said. “Now, are those the people that are going to vote in the Republican primary? I don’t know.”

What Rice does know: His political future could come down to one vote.

A multi-day winter storm is dropping freezing rain and snow over much of the central U.S. in the second blast of severe weather in a week. This time, a lot more Americans are expected to be affected, with the storm’s path spanning more than 2,000 miles.

The National Weather Service on Tuesday issued winter storm warnings and watches from Texas counties near the Mexican border, stretching northeast to the Great Lakes and along the Canadian border, and extending to the northern tip of Maine, with about 100 million people in its path.

As much as 14 inches of snow had been projected to fall on parts of Illinois and Indiana on Wednesday. By the afternoon, Chicago’s Midway airport recorded 11 inches. Lewistown, in central Illinois, saw more than 14 inches of snowfall, and observers in the northeastern Missouri city of Hannibal reported more than 11 inches.

While snow has tapered off across Illinois, according to NWS, winds clocking as high as 40 mph could blow snow south, posing a hazard to already-icy roads.

With the region’s heaviest snowfall moving eastward, forecasters estimated that another foot of snow could cover parts of Indiana by Thursday evening.

In a Wednesday morning briefing, Indiana Gov. Eric Holcomb urged residents to give city snowplows trucks the space to clear and treat the roads.

The combination of rain and snow, particularly in southern Indiana, will make for slick roads, said Indiana Department of Transportation Commissioner Joe McGuinness. While advising against traveling, McGuinness told reporters that evening commuters should take extra caution, since city workers won’t be able to treat the roads effectively under current weather conditions.

Officials said that some 240 National Guard members are being deployed to patrol the roads and assist any stranded drivers.

In neighboring Illinois, Gov. J.B. Pritzker announced a disaster proclamation and said he’d activate more than 100 members of the Illinois National Guard. The Illinois Department of Transportation told people to stay home, warning of as much as 20 inches of snow before the storm ends.

Missouri Gov. Mike Parson signed a disaster declaration that he said would enable “emergency management professionals to have every tool and resource available to aid Missourians, protect lives, and respond to this winter storm.”

“Severe winter weather isn’t something we are strangers to,” he said in a written statement. “But we must be prepared for the worst.”

The storm could also bring crippling ice to an area from eastern Arkansas to western Kentucky that could last into the weekend, the Weather Service warned — likely knocking out power and causing tree damage and dangerous travel conditions.

In preparation, Kentucky Gov. Andy Beshear ordered state government offices to close on Thursday.

“If everything holds to where it is right now, this is the real deal,” Beshear said at a Wednesday afternoon news conference.

Much of northern Texas was under a winter storm warning as of Wednesday evening and up to 3 inches of ice and sleet could fall in the Dallas-Forth Worth area. Through Saturday, wind chills in the area could be as low as -10 degrees.

Last February, a winter storm there with record cold temperatures left millions of people without power for days. Water treatment plants closed, forcing people to boil water.

Snow-covered roads and low visibility created dangerous driving conditions. In Missouri, officials are pleading with motorists to reduce their speed, posting photos of the consequences. In central Missouri, crashes shut down parts of Interstate 70 at least twice on Wednesday.

More than 2,300 flights within, into and out of the U.S. had been canceled as of Wednesday night, according to the website Flight Aware, and another 3,500 had been canceled for Thursday.

The storm will reach the Northeast on Thursday, potentially bringing up to 3 feet of snow in parts of New York, Vermont, New Hampshire, and Maine by Saturday morning. A storm across the region last weekend left thousands of people without power, which has since been restored.