Charles Gaba's blog

I can't begin to tell you what a Big Deal® lots of people made this announcement out to be three years ago...without having a clue WTF it was actually about:

Amazon, Berkshire, JPMorgan Move to Target Health-Care Costs

Three corporate giants are teaming up to combat what billionaire Warren Buffett calls a “hungry tapeworm” feasting on the U.S. economy: health care.

OK, I'm interested...

Just announced moments ago:

As part of the state’s overall response to the coronavirus, and in an effort to prioritize health and safety, Maryland Health Connection opened a new special enrollment period for uninsured Marylanders to enroll in a private health plan. Here’s what you need to know:

When your coverage begins

The coronavirus emergency special enrollment period will begin immediately and ends Monday, March 15. Here are the dates coverage will begin, depending on what day you enrolled in a health plan:

  • Enroll now-Jan. 15, coverage starts Jan.1
  • Enroll Jan. 16-Feb. 15, coverage starts Feb.1
  • Enroll Feb. 16-March 15, coverage starts March.1

How do I enroll?

To enroll, visit MarylandHealthConnection.gov or download the free “Enroll MHC” mobile app. Select “Coronavirus Emergency Special Enrollment Period.”

Access Health CT, Connecticut's state-based ACA exchange, has updated their enrollment summary and now reports 102,190 residents have selected policies for 2021, including 15,310 new enrollees.

Last year they had a total of 107,833 QHP selections during Open Enrollment, which they're 5.2% away from breaking.

Connecticut residents still have until January 15th to #GetCovered via AccessHealthCT.com.

The data below comes from the GitHub data repositories of Johns Hopkins University, except for Utah, which comes from the GitHub data of the New York Times due to JHU not breaking the state out by county but by "region" for some reason.

I've made some more changes:

  • I've now completed updating the partisan lean for every county except Alaska to the 2020 Biden/Trump results. Alaska still uses the Clinton/Trump 2016 results, although I can't imagine more than one or two regions changed status there this year.
  • I've also added columns listing the actual Biden/Trump vote percentage for each county to give a feel for how partisan it is. Again, I'm defining "Swing District" as any county where the difference is less than 6.0%. There's 188 swing districts (out of over 3,100 total), with around 33.8 million Americans out of 332 million total, or roughly 10.2% of the U.S. population.
  • I've also added all U.S. territories, including a county-equivalent breakout for Puerto Rico, as well as American Samoa, Guam and the U.S. Virgin Islands. None of these vote in the general Presidential election, of course, but I'm still tracking their COVID-19 case & death rates. None show up in the top 100 of either ranking, however. Note that Puerto Rico only includes the case breakout, not deaths, which are unavailable for some reason.

With these updates in mind, here's the top 100 counties ranked by per capita COVID-19 cases as of Thursday, December 31st, 2020 (click image for high-res version).

Blue = Joe Biden won by more than 6 points; Orange = Donald Trump won by more than 6 points; Yellow = Swing District

A picture is worth 1,000 words and all that.

I've done my best to label every state/territory, which obviously isn't easy to do for most of them given how tangled it gets in the middle. For cases per capita, the most obvious point is that New York and New Jersey, which towered over every other state last spring, are now utterly dwarfed by North & South Dakota, although their surge seems to be finally dropping (although "dropping" is a relative term...it's still pretty awful everywhere).

North Dakota has broken 12% of the entire population having tested positive. South Dakota is up to 11%. A half-dozen other states are hovering between 8-9% of the population being infected.

via NY State of Health:

Press Release: As Key Enrollment Deadline Approaches, NY State of Health is Urging Consumers to Sign up Today for Health Coverage Starting January 1

ALBANY, N.Y. (December 29, 2020) - NY State of Health, New York’s official health plan Marketplace today is reminding New Yorkers who are applying for Qualified Health Plan coverage, there is still time to enroll for health coverage effective January 1, 2021. In response to the COVID-19 pandemic, NY State of Health is giving New Yorkers more time to enroll in Qualified Health Plan Coverage – consumers who sign up by December 31, 2020, will have coverage starting January 1, 2021.

“High-quality, affordable health coverage is more important than ever as the pandemic continues to surge,” said NY State of Health Executive Director, Donna Frescatore. “With the December 31 deadline quickly approaching we encourage anyone who needs coverage to view their options, sign up today and start the New Year with appropriate coverage.”

via Samantha Liss at HealthCare Dive:

It's unsurprising the nation's hospital lobby lost its latest legal challenge in the case to force hospitals to reveal the negotiated rates they reach with insurers for services provided to patients.  

The three-judge panel was highly skeptical of the hospital lobby's claims when it heard oral arguments in October and pushed back in their line of questioning.

...The undoing of the case may have been when AHA's litigator told judges certain prices are "unknowable." 

That only provoked more questions from primarily two of the three judges who seemed baffled by the assertion that prices were unknowable. Judges Merrick Garland and Tatel — both appointed by former President Bill Clinton — launched into a lively line of questioning about the cost of X-rays. 

...The hospital lobby had argued that it's impossible to know the rates because in some instances a patient may require more care than was originally anticipated. 

Normally I receive notices about these types of data reports directly from CMS via their mailing list, but this time around it wasn't emailed and in fact isn't even posted on the CMS newsroom archive  (at least not yet). Fortunately, my eagle-eyed colleague Andrew Sprung grabbed the link from a Health Affairs article and wrote up his own analysis of it.

via Get Covered NJ:

Final Days to Enroll in Health Insurance at Get Covered New Jersey for January 1st Coverage

  • ​Residents Must Enroll by Dec. 31 for Coverage Beginning in the New Year; 8 in 10 Qualify For Financial Help

TRENTON – Department of Banking and Insurance Commissioner Marlene Caride today reminded New Jersey residents that there are three days left to enroll in health coverage that starts on the first of the year. New Jersey residents can shop for quality, affordable health insurance at the state’s official health insurance marketplace, Get Covered New Jersey. Residents must select a plan by December 31, 2020 for coverage beginning January 1, 2021.

via Your Health Idaho:

Final Deadline for Health Insurance in Idaho is December 31

  • Your Health Idaho anticipates increased activity following deadline extension

BOISE, Idaho – Idahoans looking to find 2021 health insurance coverage still have a few days left to enroll through the state health insurance exchange, Your Health Idaho.

After extending the original deadline from Dec. 15, exchange officials are urging Idahoans to apply for the monthly health insurance tax credit and make their final plan selection by 11:59 p.m. (MT) on Thursday, Dec. 31. 

“I cannot stress enough how important this final deadline is for Idahoans,” said Pat Kelly, Your Health Idaho Executive Director. “Even if you are unsure if you will qualify, this is the last chance to complete an application and find out if you are eligible for lower-cost coverage through Your Health Idaho.”

via Covered California:

  • The first major open-enrollment deadline is this week: Consumers who want their coverage to start on Jan. 1 need to sign up by Dec. 30.
  • The deadline comes as COVID-19 infections and deaths continue to rise across California, with hospitals overloaded with patients and limited ICU bed capacity.
  • Having health care coverage, staying COVID-safe and getting vaccinated when you are able to are critical to helping overcome the pandemic.
  • More than 1.2 million Californians are uninsured right now, even though they are eligible for financial help from Covered California, or low-cost or no-cost coverage through Medi-Cal.
  • Covered California’s open-enrollment period runs through Jan. 31.

The data below comes from the GitHub data repositories of Johns Hopkins University, except for Utah, which comes from the GitHub data of the New York Times due to JHU not breaking the state out by county but by "region" for some reason.

I've made some more changes:

  • I've now completed updating the partisan lean for every county except Alaska to the 2020 Biden/Trump results. Alaska still uses the Clinton/Trump 2016 results, although I can't imagine more than one or two regions changed status there this year.
  • I've also added columns listing the actual Biden/Trump vote percentage for each county to give a feel for how partisan it is. Again, I'm defining "Swing District" as any county where the difference is less than 6.0%. There's 188 swing districts (out of over 3,100 total), with around 33.8 million Americans out of 332 million total, or roughly 10.2% of the U.S. population.
  • I've also added all U.S. territories, including a county-equivalent breakout for Puerto Rico, as well as American Samoa, Guam and the U.S. Virgin Islands. None of these vote in the general Presidential election, of course, but I'm still tracking their COVID-19 case & death rates. None show up in the top 100 of either ranking, however. Note that Puerto Rico only includes the case breakout, not deaths, which are unavailable for some reason.

With these updates in mind, here's the top 100 counties ranked by per capita COVID-19 cases as of Friday, December 25th (click image for high-res version).

Blue = Joe Biden won by more than 6 points; Orange = Donald Trump won by more than 6 points; Yellow = Swing District

A picture is worth 1,000 words and all that.

I've done my best to label every state/territory, which obviously isn't easy to do for most of them given how tangled it gets in the middle. For cases per capita, the most obvious point is that New York and New Jersey, which towered over every other state last spring, are now utterly dwarfed by North & South Dakota, although their surge seems to be finally dropping (although "dropping" is a relative term...it's still pretty awful everywhere).

North and South Dakota are the first two states where more than 10% of the entire population has tested positive (in fact, North Dakota is about to hit 12%). A few other states could all potentially hit the 10% milestone by New Year's Eve as well.

UPDATE 12/31/20: The deadline to submit public comments has passed. In the end, there are 320 comments, 243 of which were submitted after I posted this entry. The wording on a random check of some finds that at least a couple dozen appear to have been guided by my own sample comment below, which I'm glad to see.

Now we'll just have to wait and see. Thank you to everyone who helped out!

Last month, I wrote about the annual Notice of Benefit & Payment Parameters for 2022 (NBPP) from the Centers for Medicare & Medicaid (CMS). This is a long, wonky document published each year which includes a bunch of proposed modifications to various aspects of how the ACA is administered and implemented.

Some of the proposed changes each year are pretty much mandatory. Some are completely up to whoever is running CMS/HHS at the time. Some are nominal tweaks; some are major changes.

Way back in October 2013, I launched the ACA Signups project as a light, nerdy hobby thing which was only supposed to last around six months, through the end of the first ACA Open Enrollment Period (March 31, 2014). Instead...well, let's just say that it's more than seven years later and I'm still doing this.

The reality is that The Graph itself doesn't serve a whole lot of useful function anymore. The enrollment patterns were erratic the first couple of years but have since settled into a pretty predictable...if not downright boring pattern for both the federal and state exchanges. The main reason I keep doing it each year is mostly out of tradition these days; after all, without The Graph, there wouldn't be an ACA Signups and I wouldn't have become a healthcare policy wonk in the first place.

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