For several years now, I've been urging Congress to upgrade the Affordable Care Act via a series of major improvements. Most notable among these is the need to #KillTheCliff...that is, to eliminate the so-called "Subsidy Cliff" which kicks in for ACA individual market enrollees who earn more than 400% of the Federal Poverty Line (roughly $50,000 for a single adult or $103,000 for a family of four).
As I've explained many tmes, the ACA's subsidy structure works pretty well for those earning between 100 - 200% FPL, and is at least acceptable for those earning 200 - 400% FPL (in fact, thanks to #SilverLoading, it works quite well for most of that population as well). The real problem kicks in above 400% FPL (and to a lesser extent below 138% FPL for those living in the 14 states which still haven't expanded Medicaid). In addition, the subsidy formula still doesn't make policies truly affordable for many of those receiving them.
In short, both the upper- & lower-bound Subsidy Cliffs need to be eliminated, and the underlying formula needs to be strengthened as well.
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 Sunday, June 14th:
As promised, here's my weekly update of the spread of COVID-19 across all 50 states, DC & PR over time, from March 20th through June 14th, 2020, in official cases per thousand residents.
I've given up trying to tie every trend line to the state name; it simply gets too crowded near the bottom even with a small font size, so I've grouped some of them together where necessary.
Note that this graph doesn't take into account any of the rumored undercounts in Florida, Georgia etc...these are based on the official reports from the various state health departments. If and when those are ever modified retroactively I'll update the data accordingly.
Click the image itself for a high-resolution version.
Note: The sudden jumps in New York, Massachusetts and Michigan all reflect reporting methodology changes; MA & MI started including probable COVID-19 cases, while New York added a batch of 15,000 positive antibody tests results they hadn't been previously including.
Hardly surprising given how vile the current administration is about everything else, but still a bit of a break from the All-COVID-19/BLM Protests, All The Time news of late. Via Dan Diamond of Politico:
The Trump administration on Friday formally rolled back an Obama-era policy that protected LGBTQ patients from discrimination and required robust language translation services, unnerving health experts who worry vulnerable populations will face further risks during the Covid-19 pandemic.
The move — long sought by some of President Donald Trump's supporters in the conservative Christian community — is the latest effort by Trump to mobilize his religious base amid criticism over his handling of the coronavirus outbreak and the recent protests over the death of George Floyd in police custody.
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.
The bill in question wasn't terribly complicated; it essentially just placed a new fee on health insurance carriers to finance a new fund which would in turn be used to reduce healthcare coverage costs for low- and middle-income New Mexicans. Furthermore, since some of the fees would be imposed on managed Medicaid programs which are mostly federally funded, it would have leveraged tens of millions of dollars in federal funding as opposed to all of the fees coming from state residents. Had it gone into effect, HB 278 was expected to generate around $125 million in revenue for the state to use to reduce premiums and cost sharing for enrollees.
NEARLY 40,000 MARYLANDERS HAVE ENROLLED DURING CORONAVIRUS EMERGENCY SPECIAL ENROLLMENT PERIOD
Less than a week left for uninsured residents to get marketplace coverage
BALTIMORE, MD – The Maryland Health Benefit Exchange today is urging uninsured Marylanders to enroll in coverage before the June 15 deadline through the state’s health insurance marketplace, Maryland Health Connection, under the Coronavirus Emergency Special Enrollment Period. To date, nearly 40,000 residents have received health coverage during this special enrollment period that began in March with Gov. Larry Hogan’s announcement of a State of Emergency in Maryland.
Over a year ago, I wrote an analysis of H.R.1868, the House Democrats bill that comprises the core of the larger H.R.1884 "ACA 2.0" bill. H.R.1884 includes a suite of about a dozen provisions to protect, repair and strengthen the ACA, but the House Dems also broke the larger piece of legislation down into a dozen smaller bills as well.
Some of these "mini-ACA 2.0" bills only make minor improvements to the law, or make improvements in ways which are important but would take a few years to see obvious results. Others, however, make huge improvements and would be immediately obvious, and of those, the single most dramatic and important one is H.R.1868.
The official title is the "Health Care Affordability Act of 2019", but I just call both it and H.R.1884 (the "Protecting Pre-Existing Conditions and Making Health Care More Affordable Act of 2019") by the much simpler and more accurate moniker "ACA 2.0".
Health Carriers Propose Affordable Care Act (ACA) Premium Rates for 2021
BALTIMORE – Health carriers are seeking a range of changes to the premium rates they will charge consumers for plans sold in Maryland’s Individual Non-Medigap (INM) and Small Group (SG) markets in 2021.
The rates submitted for the INM market include the estimated impacts from the state-based reinsurance program (SBRP) enacted in 2019 via a 1332 State Innovation Waiver, approved by the federal Centers for Medicare & Medicaid Services.
“As CEO of the Washington Health Benefit Exchange, I have been saddened and horrified by the brutal death of George Floyd while in police custody. His death represents one of the most recent in a long history of violence against black people, including Philando Castile, Breonna Taylor, and Ahmaud Arbery, and far too many others. As communities across the state and the nation voice their justified anger and frustration, we stand with the Black community and all communities of color. This tragic event reminds our leadership and staff of the urgent need to continue to address structural racism as a way to narrow health disparities, especially in communities of color.
“We, too, are deeply concerned about the property damage taking place in our cities. It is harmful to so many people, including the communities who are working to make their voice heard. We choose to focus on the protestors’ message of racial justice over the damage being committed by a disorganized few, because property is replaceable and Black lives are not.
