SAN FRANCISCO — A federal judge Wednesday denied a petition to immediately reinstate Affordable Care Act subsidies that President Donald Trump suspended earlier this month.

The ruling came in a filed by 18 states and the District of Columbia, led by California Attorney General Xavier Becerra. It sought an emergency restraining order compelling the Trump administration to resume the Obamacare payments, which would have totaled $7 billion this year.

In his ruling, U.S. District Judge Vince Chhabria wrote that “the emergency relief sought by the states would be counterproductive.”  He said the vast majority of states have already prepared for the termination of the payments and already “devised responses that give millions of lower-income people better health coverage options than they would otherwise have had.”

Earlier this month, the Trump administration  ended the so-called cost-sharing subsidies that compensate insurers for discounts given to low-income consumers to help cover their out-of-pocket expenses under policies sold on the ACA marketplaces. Officials argued that the subsidies are illegal because they have not been approved by Congress.

These subsidies are different from the tax credits many consumers get, depending on their income, to pay Obamacare premiums.

Chhabria said whether the funds were properly appropriated remains an open question as the lawsuit continues. His decision dealt only with the restraining order.

Becerra vowed to continue the legal battle to reinstate the payments.

“The fight for affordable healthcare moves forward,” Becerra said in a statement. “The actions by the Trump Administration undermine critical payments that keep costs of healthcare affordable for working families. The judge made clear in his ruling that the ACA is the law of the land. Without an emergency order halting the Trump action, swift action in this litigation becomes even more compelling.”

The ruling was expected. Chhabria expressed skepticism Monday that Trump’s decision to halt the subsidies would cause consumers immediate harm, as California and many other states claimed in the suit.

Since assuming office in January, Trump has repeatedly threatened to stop the cost-sharing subsidies. But he held off while Republicans in Congress were working to replace the ACA.

Responding to the uncertainty, a number of states have allowed insurers to raise their premiums. California earlier this month ordered insurers to add a to some policies next year, to offset the potential loss in federal funding and keep the individual insurance market stable. The 12.4 percent surcharge was added to silver plans only, the second-least-expensive tier.

“California is doing a really good job in responding to the termination of [cost-sharing reduction] payments in a way that is avoiding harm for people and actually benefiting people,” said Judge Chhabria.

He said that the vast majority of states have “seen the writing on the wall” and chosen to respond by increasing premiums for silver plans. That, in turn, will force the federal government to give higher tax credits to most consumers, so they won’t feel any financial pinch.

Under intense questioning by the judge, California Deputy Attorney General Gregory Brown acknowledged that California has done a lot to mitigate the harm to consumers. But he said the administration’s actions are destabilizing the exchanges and the individual insurance market, and causing chaos for states and consumers just eight days before enrollment begins Nov. 1.

Some experts and states are concerned jumpy insurers will bolt from the market and leave some regions with minimal or no choices for coverage. However, a bipartisan bill in Congress would restore the cost-sharing subsidies and aims to stabilize the insurance markets. But it’s not clear the bill will muster the support it needs to pass both the Senate and House or whether Trump would sign it.

In California, 1.4 million people buy their own coverage through the state marketplace, and 90 percent receive federal subsidies that reduce what they pay.

During the hearing, Chhabria read from a Covered California that predicts how the changes will affect consumers in 2018. It notes that even though silver plan premiums will rise as a result of the surcharge, the federal tax credits will also increase to cover the rise in premiums. That would leave 4 out of 5 consumers with monthly premiums that stay the same or decrease.

The judge also said ruling in favor of the restraining order would mean insurance companies could essentially “double collect” — benefiting from both the premium increases from the surcharge on silver plans and the cost-sharing subsidies.

Brown said a restraining order to resume the cost-sharing payments would bring back the status quo. If insurance companies double collect, the state would compensate by reducing rates down the line, he said.

“We’re not looking to give insurance companies a windfall … but the stability is important to insurance companies,” he said.

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Lockett, 70, says he never leaves home without an emergency inhaler.

His senior housing complex in East Oakland is less than a mile from Interstate 880, a major corridor for freight trucks shuttling to and from the Port of Oakland. On the way to factories and warehouses, the trucks often roll through streets near homes, schools and libraries.

The diesel-fueled big rigs are a major source of air pollution, spewing soot and other pollutants that can cause or aggravate respiratory conditions such as asthma and bronchitis.

Just walking while talking on his cellphone can leave him short of breath, Lockett said. “The [asthma] triggers here, without my medications, it would be terrible.”

California has cleaned up its diesel fleet significantly in recent years by phasing out older trucks and requiring operators to install the latest pollution-control equipment. But local air district officials and environmental advocates say more needs to be done and that the emissions goal should be close to zero.

Efforts to get there are stalled, they say, in part because of a provision in the $52 billion road improvement  signed in April by Gov. Jerry Brown. That provision exempts most diesel trucks on the road from future emissions reduction requirements for many years.

Regulators and environmentalists warn that, without further reductions in emissions, many residents who live near major truck routes or the port remain at high risk of cancer, heart problems, asthma and other lung diseases, especially and .

Asthma is a critical problem in Oakland for these two groups. Among other indicators, the rate of emergency room visits for asthma among seniors (age 65 and older) in East Oakland, where Lockett lives, is nearly three times higher than it is statewide, and the rate in West Oakland is nearly two times higher, according to state and county data.

Similarly, children in these neighborhoods go to the emergency room for asthma at more than double the rate of their peers statewide, according to 2016 data. In the heart of West Oakland, near the port, nearly 21 percent of children have been diagnosed with asthma, according to 2014  from the California Health Interview Survey. That’s well above the statewide average of 15 percent.

A mobile asthma clinic called a Breathmobile regularly parks at elementary schools near the port, and Darryl Carter makes good use of it for son Austin, 13. During a recent visit, he recalled a terrifying attack eight years ago that sent Austin to the hospital. Since then, the boy’s been back to the hospital three or four times — not ideal, but the Breathmobile visits have made a difference.

Asthma has multiple causes and triggers, including poor housing conditions, a family history of the disease, certain weather conditions and exposure to cigarette smoke. Poverty, lack of access to health care and little knowledge of preventive care all can contribute to high rates of emergency visits, said Dr. Washington Burns, administrative director of the Breathmobile in Northern California.

However, “there’s often more asthma around corridors with trucks and cars than in areas where there aren’t,” Washington said.

Diesel trucks account for 2 percent of vehicles but emit 30 percent of key smog-forming nitrogen oxides and 65 percent of the soot attributable to motor vehicles, according to the state Air Resources Board (ARB).

A ‘Dirty Deal’?

In 2015, the Oakland City Council began diverting trucks from streets with homes, schools or senior centers. But some community activists say enforcement of these local ordinances has not been strong enough.

The provision in the state’s new law exempts all but the oldest or highest-mileage trucks from any new emission reduction rules the state might impose. The exemption lasts 18 years from the time they meet current emissions standards or until they have traveled 800,000 miles.

It’s unclear exactly how the exemption will affect local air districts and ports that want to cut emissions further. Environmentalists say these agencies may face resistance and risk being sued by the trucking industry if they forge ahead with more aggressive plans.

Critics say the governor agreed to the last-minute exemption to gain the trucking industry’s support for higher diesel and gas taxes that, along with vehicle fees, are expected to raise $5.2 billion annually over 10 years to repair roads and bridges and to expand public transit.

Bill Magavern, policy director for the Sacramento-based Coalition for Clean Air, said improving infrastructure is laudable but should not come at the cost of clean air.

“There’s a lot to like in that bill, and we hated to oppose it,” but there was a “dirty deal” thrown in at the last minute, Magavern said.

Gov. Brown’s office referred questions on the truckers’ amendment to the ARB, the state’s clean-air agency.

The ARB said it can provide incentives to further reduce emissions without imposing additional requirements. And the new law, it said, will strengthen enforcement of existing rules.

Under the law, “truck operators can be denied [Department of Motor Vehicles] registration if they’re not meeting the current rules,” board spokesman David Clegern said. “Diesel pollution will be reduced by bringing 300,000 more trucks into compliance.”

Local air managers in Southern California say greater enforcement of current rules is important, but it won’t sufficiently accelerate turnover of the truck fleet. And that’s crucial to helping Southern California meet federal clean-air standards, said Philip Fine, deputy executive officer of planning and rule development with the South Coast Air Quality Management District.

The problem for local air districts and ports is that when it comes to directly regulating mobile sources of pollution like diesel trucks, the state is the boss. It approves local district plans, and the local districts more or less oversee the ports. So the most effective way to reduce trucker emissions is to set stringent policy at the state level, as California has aggressively done in the past.

Emissions Way Down

But truckers say the state has imposed enough requirements. Chris Shimoda, vice president of government affairs for the California Trucking Association, said diesel emissions from trucks in California ports have fallen dramatically in recent years.

“This is attributable to the current $1 billion annually being invested by truckers in the cleanest available technology throughout the state,” Shimoda said.

He also said that being exempted from any future state emissions-reduction requirements reassures the trucking industry that it will recoup the investment it is making in new engines to meet current state standards.

Under existing state rules, owners of heavy-duty trucks must have 2010 or newer-model engines by 2023.

Those rules have dramatically improved air quality. A by the Bay Area Air Quality Management District, among others, found that from 2009 to 2013 emissions of black carbon from trucks at the Port of Oakland dropped by 76 percent and nitrogen oxides by 53 percent.

Critics: More Progress Needed

Still, ports throughout the state rely mostly on diesel to power vessels, yard equipment, trains and trucks. Ports in Southern California remain the single-largest fixed source of smog-forming pollution in the region. And the Port of Oakland is the largest fixed emitter of diesel pollution in the Bay Area, local air managers say.

That’s why local districts were alarmed by the governor’s concession to the trucking industry, said Tom Addison, legislative and policy adviser for the Bay Area air district.

It “gives the trucking industry a get-out-of-jail-free card,” said David Pettit, senior attorney with the Natural Resources Defense Council. “It bars any kind of state regulations that might require truckers to move to a different kind of truck — natural gas-powered, electric or hydrogen fuels — when those become available in the market.”

Last month, the mayors of Los Angeles and Long Beach set ambitious for the ports to transition to zero-emission truck and yard equipment over the next 20 years. The mayors affirmed that the ports’ 2017 clean-air blueprint, which is expected to be released Wednesday, will include further emissions reductions from ships and the development of a zero-emissions truck pilot program.

But the new state law calls into question whether those plans — and others in coming years — will be enforceable.

If the ports in Southern California announced that in five years they’re going to have an all zero-emissions fleet, Pettit said, “they’d be sued [by the trucking association] in a heartbeat.”

CORRECTION: This story was updated on July 18 to correct the title of Philip Fine, who is deputy executive officer of planning and rule development at the South Coast Air Quality Management District.  Also corrected is the national ranking of the Port of Oakland as described in one of the picture captions. It is the nation’s seventh largest seaport.

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The West Oakland Environmental Indicators Project, in partnership with researchers at the University of California, Berkeley, installed the first 25 of the 100 sensors they plan to place in the area, whose residents have long been burdened by diesel pollution from ships, trains and heavy-duty trucks coming in and out of the port. The devices will be stationed in the residents’ yards, schools, senior centers and businesses.

Diesel pollution accounts for about 70 percent of the known cancer risk related to air toxins in California, according to the state . The health effects of diesel also include chronic heart and lung diseases, such as asthma and chronic obstructive pulmonary disease (COPD), as well as decreased lung function in children. These, in turn, can lead to ER visits, hospitalizations and premature deaths.

Oakland’s asthma rate in children (19 percent) and adults (16 percent) is on par with Alameda County, where the city is located. But, asthma rates are higher for children in West Oakland, near the port, where the number of kids diagnosed with the disease is nearly 21 percent, according to data from the California Health Interview Survey (AskCHIS, 2014). Statewide, 15 percent of children and 14 percent of adults have had an asthma diagnosis.

The rate of asthma-related emergency room visits is nearly twice as high in Oakland as in Alameda County,

California has reduced diesel pollution in a number of ways, including programs to retrofit trucks with equipment that makes them run more cleanly and a gradual phaseout of older trucks. Since 1990, diesel pollution in the state has decreased by 68 percent, according to the Air Resources Board.

Government and business investments to clean up trains, ships and trucks operating at the Port of Oakland have dramatically reduced diesel particle emissions there by 75 percent since 2015, according to a released last year by the port.

However, the passage of a sweeping bill by state lawmakers last Thursday to pay for road repairs contains a that could make it harder for the state to regulate emissions from the trucking industry.

Brian Beveridge, co-founder of the West Oakland Environmental Indicators Project, says diesel pollution from port activities must be further reduced.

Last week, the West Oakland Environmental Indicators Project , alleging that by forging ahead with a planned port expansion, the city and Port of Oakland are ignoring the disproportionate health impacts on West Oakland residents. Half of the residents are African-American, and the neighborhood has one of the highest poverty rates in the county.

Beveridge says people in West Oakland are still concerned about the dangers of dirty air, and they think more detailed monitoring is needed to clearly understand the quality of the air they are breathing.

California Healthline interviewed Beveridge last week. His comments have been edited for length and clarity.

Q: What are the sources of pollution in the neighborhood?

West Oakland is surrounded by three freeways. The primary route for trucks is Interstate 880 on the south and west sides of the community and upwind of West Oakland. The biggest sources of diesel and fuel oil emissions are the port and its various activities — ships, cargo handling equipment, railroads and trucks. The freeway is next, upwind of the neighborhood.

Q: What do we know about exposure to diesel pollution and health?

Diesel pollution has been known for a decade to have a significant health impact. Today, it’s seen as a cause of asthma, of COPD, lung cancer and brain cancer — because they found a component in diesel emissions that can cross over the blood-brain barrier. The U.S. Environmental Protection Agency said that diesel emissions nationwide were potentially the cause of 85 percent of all respiratory illness in the country. Millions and millions of people suffering from completely preventable illnesses.

Q: What has California done to address the problem of dirty diesel?

In the early 2000s, the state needed to rebuild the freight infrastructure — freeways, bridges, railways and ports. Moving cargo was becoming a key industry in California. [The state] set a target of reducing diesel emissions by 85 percent of 1994 levels, so we’re still trying to reach that 85 percent reduction.

In 2008, the trucks carrying cargo were targeted first because they operate so close to port and fenceline communities. For a year, the state provided incentives for the trucking industry to upgrade their hardware. … In [the Port of] Oakland, [the state provided] $30 million to $40 million to help truckers buy diesel particulate filters (DPS). Those filters used new technology to reduce diesel emissions from trucks by 85 percent, and older trucks were phased out.

Q: There’s been progress on cleaning up the air, but is there still a problem?

Even though the port projects will achieve the 85 percent goal by about 2020, because of cargo volume growth, it will exceed [the emissions cap set by] those goals again by 2028. … [Even with the 85 percent reduction], the 15 percent left over is still a significant amount if you look at it in aggregate, [and] that number will grow.

Q: Why is additional air monitoring in the neighborhood needed, and what data will be collected?

The current project is an attempt to look at the finely granular picture of air quality on the ground where people live. The regulatory agencies set ambient air standards to regulate air quality. That means they rely on a broad network of monitoring stations about every 2 kilometers to determine the air quality in the region.

We’ve always felt measuring and regulating ambient air doesn’t do much for people who live next to power plant, a port or freeways, because these places are the sources of pollution. [Regulators should] look at the source [of pollution] and regulate cleaning up the source of the problem. That’s been quite a struggle. When you talk about sources of pollution, you’re talking about industry spending money to clean emissions. It’s easier to talk about amorphous vehicle owners and freeways and make a rule for millions of people who own a car. Those people don’t fight back.

Q: How will the data from personal air quality sensors be used?

The monitoring project we’re doing now will take ambient air and break it into 100 little bits. What are we really breathing if we look carefully at local air in the front yard?

Our goal with the data is to take a better look at traffic and land use in the community, areas where cities do have some control. When you look at zoning — how cities zone properties for business [or residential] uses — it has a significant impact on a very hyperlocal scale. A couple of hundred feet can make a difference in terms of the quality of air people breathe.

We might want to regulate the placement of child care centers, senior centers, health centers or housing for that matter.

Q: President Donald Trump has proposed slashing the EPA’s budget by nearly a third. How would that affect communities?

The bottom line, if you roll back environmental protection, more people will get sick and die. Environmental protections initiated in this country during the past 50 years under [President] Richard Nixon cleaned up air and water. People who were drinking polluted water are now drinking clean water, and people who were breathing polluted air are now breathing clean air. What the [Trump] administration is doing now will cause people to die. That’s the simplest way to describe what is happening.

What the people following Donald Trump, the administration and business don’t understand is you can’t get smaller government and pay less taxes if you have millions of people going to the hospital because they don’t have money and showing up with environmental exposure. That’s how [former governor Arnold] Schwarzenegger was able to persuade a Republication legislature to do something [about diesel pollution]. He understood you can’t get smaller if the government is spending millions on public health. You can’t get a stronger economy if you have lost workdays because people are ill.

This story was produced by , which publishes , an editorially independent service of the .

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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This story can be republished for free (details).