Charles Gaba's blog

Since I've been neglecting other ACA/healthcare posts the past couple of weeks, I figured I should at least provide regular updates on why I've been mostly absent.

I've made major progress in updating and revising my breakout of COVID-19 cases and fatalities at not just the state level but the county level. Again, I've separates the states into two separate spreadsheets:

Not terribly surprising; via the Massachusetts Health Connector:

On May 21, 2020, the Health Connector announced in an Administrative Bulletin an extension to the extended enrollment period in response to the coronavirus (COVID-19) emergency through June 23, 2020 to assist uninsured Massachusetts residents seeking health coverage. (The extended enrollment period was previously set to end May 25.)

If you need to apply for coverage, you can start by creating an application 

If you apply coverage under this special enrollment, the deadlines to complete enrollment are as follows:

Coverage Start DateEnrollment Deadline

• Coverage Start Date: June 1st: Enrollment Deadline: May 23rd
• Coverage Start Date: July 1st: Enrollment Deadline: June 23rd

Please note that if you are eligible to enroll due to normal special enrollment period rules, you can select the one that applies when you complete your application.

I've been spending a lot of time working on my county-level COVID-19 tracking project the past few weeks. I'm happy to report that I've managed to plug in the county-level case and fatality data for every thirteen states so far, so I figured this would be a good time to post a visual showing how the virus has spread over time across them in cases per capita (actually cases per thousand residents).

This is a much more useful measure than the raw number of cases since the population of each state (and county) varies so widely.

The states I've completed don't follow any particular pattern...aside from Michigan (which I started with because I live here, of course), the others are simply the states which I was able to get ahold of historic case/death toll data for from March 20th until today. Other states will follow as I complete backdating the data into the spreadsheets.

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.

On April 28th, they announced that the number was up to 84,000 new ACA exchange enrollees, averaging around 2.5x as many as enrolled via standard Special Enrollment Periods during the same period a year ago.

Today they issued another update:

Covered California Sees More Than 123,000 Consumers Sign Up for Coverage During the COVID-19 Pandemic

Note: I've been distracted by my county-level COVID19 tracking project for the past couple of weeks, so I'm posting a series of entries on various ACA/healthcare policy developments which I've missed along the way.

Back in 2016, many health insurers which had been losing money hand over fist on the ACA individual market (in spite of many making record profits in other divisions) decided to bail on the ACA market entirely. Of these, the biggest shocks to the system were Aetna, Humana and UnitedHealthcare, each of which pulled out of multiple states, and UHC bailing was the biggest blow of all:

Note: I've been distracted by my county-level COVID19 tracking project for the past couple of weeks, so I'm posting a series of entries on various ACA/healthcare policy developments which I've missed along the way.

I've missed a lot of stuff while busy diving down the rabbit hole of my county-level COVID-19 spreadsheet tracking project. This happened last week so I guess it's old news by now, but it's still both a sign of the times as well as of how hypocritical so many Republicans are about the Affordable Care Act:

Sen. John Cornyn (R-Texas) sat down for an interview yesterday with PBS Austin's Judy Maggio, who raised concerns about "holes in the safety nets" affecting many Texans. Specifically, the host noted that as more people lose their jobs during the pandemic, they're also losing their health security. Maggio asked the Senate Republican about possible federal efforts for those who are now "wondering what they're going to do for health insurance."

Cornyn's response was ... unexpected.

I've made major progress in updating and revising my breakout of COVID-19 cases and fatalities at not just the state level but the county level, and should now be able to post updated summaries of the worst-hit counties on a weekly basis.

Due to the sheer volume of data involved, I've had to separate out the states into two separate spreadsheets:

• Alabama - Missouri can be found here
• Montana - Wyoming can be found here

All data below is up to date as of Saturday, May 16th, although due to variances in when different states report the data, some of the data may be from a day earlier. The counties are color-coded depending on whether they voted for Donald Trump (orange) or Hillary Clinton (blue) in 2016.

Annnnnd we're off! In the middle of a deadly global pandemic which has already killed more than 85,000 Americans and completely disrupted the entire U.S. healthcare system, private insurance carriers still have to go about preparing their annual premium rate change filings for 2021. This is a long, complicated process which begins a good nine months before the new plans and prices are actually enrolled in.

The task of setting 2020 premiums was the first time since the ACA went into effect which was relatively calm for insurance carrier actuaries. Unlike setting rates for 2014 or 2015, they weren't dealing with a complete overhaul of the entire insurance industry. Unlike 2016-2017, they weren't dealing with the prospect of ACA premiums being crippled for 3/4 of the country (via King v. Burwell) or the fallout of the Risk Corridor Massacre. Unlike 2018, they weren't dealing with how to deal with CSR rembursements being cut off or the entire ACA being repealed by Congress. Unlike 2019, they didn't have the unknown impact of the individual mandate being repealed to consider.

Every year, I spend months painstakingly tracking every insurance carrier rate filing for the following year to determine just how much average insurance policy premiums on the individual market are projected to increase or decrease.

Carriers jump in and out of the market, their tendency repeatedly revise their requests, and the confusing blizzard of actual filing forms which sometimes make it next to impossible to find the specific data I need. The actual data I need to compile my estimates are actually fairly simple, however. I really only need three pieces of information for each carrier:

Believe it or not, even though Delaware is a fairly solidly blue state in Presidential elections, two of the three counties there (it's pretty small) voted for Donald Trump in 2016. Here's how the state's cases have shifted over time between New Castle County (the largest of the three, which voted for Clinton) and the other two counties which voted for Trump:

This is almost a complete reversal, with New Castle going from 2/3 of all cases at the beginning of April to just 1/3 today: