Charles Gaba's blog

  • Covered California approved a $440 million budget for fiscal year 2020-21 that includes a $30 million increase in marketing investments and $13 million for additional customer service upgrades to meet the needs of consumers. 
  • The increased spending, which represents a 16 percent increase over last year’s budget, comes amid continued uncertainty in the lives and livelihoods of Californians as public health officials fight against the spread of COVID-19.
  • The budget also calls for greater investments in information technology to improve efficiency, as well as increased efforts to help inform state and national policy on health care-related issues.
  • More than 209,000 people have signed up for coverage through Covered California since the exchange announced a special-enrollment period, which runs through the end of July, in response to the COVID-19 pandemic.

via the Atlanta Journal Constitution:

Gov. Brian Kemp on Wednesday extended Georgia’s coronavirus restrictions while explicitly banning cities and counties from adopting rules requiring masks or other face coverings, a measure that could bolster the state’s case in a possible legal battle.

Kemp’s executive order — which was set to expire Wednesday evening — still encourages, rather than requires, Georgians to wear masks in public. The governor has called such a requirement “a bridge too far,” and his office has said local mandates are unenforceable.

The governor’s coronavirus orders have for months banned local governments from taking more restrictive or lenient steps than the state. But the new set of rules he signed on Wednesday specified for the first time that cities and counties can’t require the use of masks or other face coverings.

For the record, here's how Georgia is doing when it comes to handling COVID-19 at the moment:

George Orwell, Nineteen Eighty-Four:

But actually, he thought as he re-adjusted the Ministry of Plenty’s figures, it was not even forgery. It was merely the substitution of one piece of nonsense for another. Most of the material that you were dealing with had no connexion with anything in the real world, not even the kind of connexion that is contained in a direct lie. Statistics were just as much a fantasy in their original version as in their rectified version. A great deal of the time you were expected to make them up out of your head.

Hardly surprising...again.

via the New York State government website:

Special Enrollment for Uninsured New Yorkers Will Extend for Additional 30 days and Remain Open Through August 15, 2020

Governor Andrew M. Cuomo today announced that the Special Enrollment Period for uninsured New Yorkers will be extended for another 30 days, through August 15, 2020, as the State continues to provide supportive services during the COVID-19 public health crisis. New Yorkers can apply for coverage through NY State of Health, New York State's health insurance marketplace, or directly through insurers.

*(more, really...see below)

I've referenced Families USA several times before (and I've attended their annual conference for the past three years), but for those not familiar with them:

Families USA, a leading national, non-partisan voice for health care consumers, is dedicated to achieving high-quality, affordable health care and improved health for all. Our work is driven by and centered around four pillars: value, equity, coverage, and consumer experience. We view these focus areas — and the various issues unique to each area — as the cornerstones of America’s health care system.

Public policy analysis that is rooted in Hill and administration experience, movement-building advocacy, and collaboration with partners are deep-rooted hallmarks of our work. In turn, our work promotes a health system that protects consumers’ financial security as much as it does their health care security.

As we advance our mission by combining policy expertise and partnerships with community, state, and national leaders, we forge transformational solutions that improve the health and health care of our nation’s families and speak to the values we all have in common.

Back in March I noted that while the U.S. Supreme Court has indeed agreed to hear the Texas Fold'Em lawsuit to strike down the Affordable Care Act (aka "Texas vs. Azar", aka "Texas vs. U.S.", aka "CA vs. TX") sometime this fall, the odds of actually getting a final decision in the case from SCOTUS before the November election (or even before either Trump or Biden are sworn into office in January) is extremely unlikely:

The ACA case was granted. It will be heard this coming term.

— Nicholas Bagley (@nicholas_bagley) March 2, 2020

#SCOTUS grants petition filed by California & other states, as well as petition filed by Texas on whether individual mandate can be separated from rest of ACA. Argument is likely in the fall, w/decision to follow by June 2021.

via the Nevada Health Link. This is from a couple of weeks ago, but still:

Nevada Health Link Announces Licensed Broker/Agent,
Navigator and In-Person Assister Recipients of Grant Program for Plan Year 2021

Carson City, Nev. –The Silver State Health Insurance Exchange (Exchange), the state agency that connects Nevadans to qualified health plans (QHPs) through the online State Based Exchange (SBE) known as Nevada Health Link, announces the licensed Brokers/Agents, Navigators and In-Person Assisters selected as part of its plan year 2021 grant program. The program is designed to help close the uninsured gap in Nevada by helping those on the frontline to more effectively market to uninsured and underinsured populations.

via the Maryland Health Benefit Exchange:

TWO SPECIAL ENROLLMENT PERIODS FOR HEALTH INSURANCE END JULY 15

  • Nearl​y 53,000 r​esidents have enrolled since mid-March

BALTIMORE, MD – The Maryland Health Benefit Exchange announced it is entering the final week for Marylanders to enroll in health insurance coverage through the Coronavirus Emergency Special Enrollment Period and the Easy Enrollment Health Insurance Program. Maryland made the decision to re-open the Coronavirus Emergency Special Enrollment Period and extend the deadline in an effort to give more residents the opportunity to enroll. Both are set to end on July 15.

The deadline extension for the Coronavirus Special Enrollment Period comes as more than 49,000 residents have received coverage during this special enrollment period that began in March with Gov. Larry Hogan’s announcement of a State of Emergency in Maryland. Even before this extension, Maryland already offered one of the longest special enrollment periods in the country since the emergency began.

via MNsure...this is from a couple of weeks ago but it's still important for all Minnesota residents to know!

ST. PAUL, Minn.—The Minnesota Insulin Safety Net Program launched today, July 1, 2020, allowing Minnesotans in urgent need of insulin (less than a 7-day supply on hand) to access the lifesaving drug through their pharmacy. The program – implemented by MNsure, the state's health insurance marketplace, and the Minnesota Board of Pharmacy – was created to help Minnesotans facing difficulty affording their insulin. 

The Insulin Safety Net Program is made up of two parts: 1) The urgent need program for eligible Minnesotans to receive a once-per-year 30-day supply of insulin immediately at their pharmacy for no more than a $35 copay; and 2) The continuing need program for eligible Minnesotans to receive up to a year supply of insulin for no more than $50 per 90-day refill.

Interested individuals should visit MNinsulin.org to see if they qualify and learn how to apply.

IMPORTANT: As noted here, I made some sort of serious data transfer error in at least two states (Michigan and Texas), making last week's "top 100" ranking questionable. For this week (and going forward) I'm triple-checking to make sure the county names, populations, case totals and fatality totals are sorted properly for all 50 states.

Now that I've brought all 50 states (+DC & the U.S. territories) up to date, I'm going to be posting a weekly ranking of the 100 U.S. counties (or county equivalents) with the highest per capita official COVID-19 cases and fatalities.

Again, I've separates the states into two separate spreadsheets:

In U.S. politics, the Hyde Amendment is a legislative provision barring the use of federal funds to pay for abortion except to save the life of the woman, or if the pregnancy arises from incest or rape. Legislation, including the Hyde Amendment, generally restricts the use of funds allocated for the Department of Health and Human Services and consequently has significant effects involving Medicaid recipients. Medicaid currently serves approximately 6.5 million women in the United States, including 1 in 5 women of reproductive age (women aged 15–44).

Federal dollars can't be used to pay for abortion outside of the above restrictions, but Medicaid is funded via hybrid federal/state funding, so there are 15 states where Medicaid does pay for abortion using the state's portion of the funding.

Back in 2018, I was all over the trend of deep red states putting ACA Medicaid expansion on the ballot after getting fed up with years of their elected leaders refusing to do so. Idaho, Utah and Nebraska voters all did exactly that, passing it by solid margins. Unfortunately, state Republicans got in the way (or at least tried to) in all three states, adding hurdles, barriers and caveats which have either delayed or partly weakened them.

Nonetheless, Utah and Idaho have both implemented Medicaid expansion to low-income residents (and thank God, given the current ongoing COVID-19 pandemic), while as far as I can tell, Nebraska is scheduled to launch their expansion program (called "Heritage Health") starting this October.

The big story with COVID-19 the past few weeks has been, of course, the out-of-control increase in new cases (if not actual deaths...yet) from the virus in red states like Texas, Florida and especially Arizona which were relatively unscathed throughout the spring while the pandemic was raging across Northeastern blue states like New York, New Jersey and Rhode Island, as well as Michigan and California.

While most of the states being hit with the summer wave are historically Republican strongholds (the states being hit hardest in June/July also include Georgia, Arkansas, South Carolina, etc.), there's one important exception to this: California, which was hit early but which clamped down fairly quickly, has re-emerged as a major hot spot. So what gives?

Thanks to Louise Norris for the heads up on this.

Over a year ago, the Washington State legislature passed (and Gov. Inslee signed) a bill to create, for the first time, a state-based Public Option healthcare plan for the individual market. As I noted at the time, there's a few important caveats which illustrate again just how difficult it is to make major overhauls to the healthcare system, even at the state level:

The good news out of Minnesota is that the Commerce Dept. has published the preliminary 2021 average rate changes for both the individual and small group markets in a simple table.

The bad news is that they haven't published any of the actual actuarial memos or templates which include the two other critical pieces of data I need to run my analysis: The current effectuated enrollee totals for each carrier, and what (if any) impact the COVID-19 pandemic had on the proposed rate changes.

I was able to estimate the former by looking at MNsure's June executive board meeting slide deck, which breaks out the on-exchange enrollment by carrier by percentage. Unfortunately, this doesn't include off-exhange enrollment. Minnesota's total individual market was around 155,000 people a year ago, so the odds are that nearly 1/3 of the total market is missing below. I also have no idea about any COVID-19 factor in the rate filings yet.

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