Yesterday, the Trump Administration formally submitted their official brief with the Supreme Court of the United States asking SCOTUS to completely and fully strike down the entire Patient Protection & Affordable Care Act. This is the latest development in the utterly insane "California vs. Texas" lawsuit (formerly "Texas vs. U.S.", "Texas vs. Azar", or as I prefer to label it, "Texas Fold'em", a name originally coined by U of M law professor Nicholas Bagley but which doesn't seem to have caught on with anyone other than me so far.
I've written about this completely absurd lawsuit more times than I care to remember, but as a reminder, here's what it comes down to.
The image below is the "3-legged stool" of the Affordable Care Act.
The blue leg represents the various patient protections which the ACA requires health insurance carriers to provide--guaranteed issue, community rating, essential health benefits and so on.
For the past few months, I've been keeping track, to the best of my ability, of how many people have been enrolling in ACA exchange policies utilizing the COVID-19-specific Special Enrollment Periods which have been offered by 12 of the 13 state-based exchanges (SBEs). My most recent update brings the grand total of confirmed SEP enrollments to at least 260,000 across 8 states, averaging around 3,500 per day.
The actual number is obviously higher than this, of course, since I don't have any data from the other four state exchanges (DC, New York, Rhode Island and Vermont), although three of those four are pretty small anyway...and even in New York, their unique "Essential Plan" (the Basic Health Plan program established under the ACA itself) has likely been sucking up the bulk of individual market enrollees earning up to 200% FPL anyway...and you can enroll in the Essential Plan year-round regardless of the pandemic. I therefore doubt that NY's COVID SEP numbers for those earning more than 200% FPL are that dramatic. All told, I'd expect NY, RI, VT & DC to only add perhaps another 25,000 or so QHP enrollees to the table below:
Nothing remotely surprising here, but it's still good to remind people of what sort of "healthcare plans" would run rampant if the ACA is struck down by the GOP's lawsuit this fall:
E&C Investigation Finds Millions of Americans Enrolled in Junk Health Insurance Plans that Are Bad for Consumers & Fly Under the Radar of State Regulators
Investigation Uncovers Troubling Tactics to Mislead Consumers into Signing Up for These Plans & then Denying or Rescinding Coverage for Medical Care
Washington, D.C. – Energy and Commerce Chairman Frank Pallone, Jr. (D-NJ), Health Subcommittee Chairwoman Anna G. Eshoo (D-CA) and Oversight and Investigations Subcommittee Chair Diana DeGette (D-CO) today released a report on the Committee’s year-long investigation into the anti-consumer practices of Short-Term, Limited Duration Insurance (STLDI) health care plans and the insurance brokers who sell and sign people up for these junk plans.
OK, this surprised me a bit: #HR1425, the Patient Protection & Affordable Care Enhancement Act, has already received a 10-year budgetary impact score from the Congressional Budget Office. I don't think this is a formal score--the whole thing is only five pages and includes minimal text accompanying it, so it might be just a "draft" score or something. I presume that if Mitch McConnell were to shock everyone and actually give it a vote in the Senate (which won't happen), there would likely have to be a second, more elaborate scoring process done by the CBO first. Then again, perhaps not.
Anyway, in a nutshell, the CBO report on the House version of H.R. 1425 comes to the following conclusions regarding the budget impact and other, related results of the bill being implemented nationally. Keep in mind that this assumes that the bill became law and was implemented starting in 2021; the score includes the 10 year period from 2021 - 2030:
TITLE I: Lowering Healthcare Costs & Protecting People w/Pre-Existing Conditions:
OK, I don't know if I "scooped" everyone with my H.R. 1425 explainer yesterday or what, but the House Energy & Commerce Committee just now sent out an official press release announcing the bill, along with a one-page summary, more detailed explainer and the link to the text itself. It's kind of interesting to see what language they use and which sections they emphasize, espeically as compared & contrasted with my own write-up:
Health Committee Chairs Unveil Legislative Package to Make Health Care & Prescription Drugs More Affordable
Legislation Also Expands Access to Health Care, Protects People with Pre-Existing Conditions & Reverses Administration’s Ongoing Sabotage of the ACA
Health Connector extends enrollment an additional month to July 23rd for uninsured individuals
On June 22, 2020, the Health Connector announced in an Administrative Bulletin an extension to the special enrollment period in response to the coronavirus (COVID-19) emergency through July 23, 2020 to assist uninsured Massachusetts residents seeking health coverage. (The extended enrollment period was previously set to end June 23.)
On April 14th, Covered California reported that 58,000 residents had enrolled in ACA exchange coverage during their COVID-19 Special Enrollment Period, of which roughly 20,000 did so via standard SEPs (losing coverage, moving, getting married/divorced, etc), while an additional 38,000 took advantage of the COVID-specific SEP.
Back in early March (a lifetime ago given the events of the past few months), House Democrats were on the verge of finally voting on a suite of important ACA protections, repairs and improvements which I've long dubbed "ACA 2.0" (the actual title of the first version of the "upgrade suite" bill was ridiculous when it was first introduced in 2018, and the slightly modified version re-introduced in 2019 was somehow even worse, no matter how good the bill itself was).
The game plan was to hold a full floor vote in the House on H.R. 1884 (or possibly a slightly different variant) the week of March 23rd, 2020 to coincide with the 10th Anniversary of the Affordable Care Act itself. This would have made perfect sense both symbolically as well as policywise, as the ACA desperately needs a major upgrade (and it would've needed one even without years of Trump/GOP sabotage, I should note).
The big story re. the coronavirus pandemic the past week or two is how it's shifting from the mostly northeastern states ravaged by it from March - May to now hitting the sunbelt, south and southwestern states in June (and likely July). With that in mind, here's graphs showing the cumulative per capita increase in positive COVID-19 cases and fatalities over time in the 5 states with the highest cases (all of which happen to be Dem-controlled, w/the exception of Massachusetts having a Republican governor) vs. the 5 states with the highest percent increase in cases over the past week (all of which happen to be GOP-controlled).
I've also included the per capita cumulative testing for each as well, since it's reasonable to expect positive cases to increase as testing ramps up. The critical thing to look for is whether the rate of the upwards curve is greater for testing or new cases. If the testing rate is increasing faster than the case rate, that's a Good Thing. If the case rate is increasing faster than the test rate, that's a Bad Thing.
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 40 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:
Most of the data comes from either the GitHub data repositories of either Johns Hopkins University or the New York Times. Some of the data comes directly from state health department websites.
Here's the top 40 counties ranked by per capita COVID-19 cases as of Saturday, June 20th:
