Charles Gaba's blog

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:

Happy Father's Day. Here's my weekly update of the spread of COVID-19 across all 50 states, DC & PR over time, from March 20th through June 21st, 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 and Massachusetts reflect reporting methodology changes; MA 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. Michigan's probable cases have been retroactively added into each daily total.

via Covered California:

Statement from Peter V. Lee on Protecting Individuals from Discrimination Based on Categories Like Gender Identity and Sexual Orientation

SACRAMENTO, Calif. — Covered California Executive Director Peter V. Lee released the following statement following the federal administration’s June 12 rule that eliminates preexisting federal rules protecting individuals from discrimination based on categories like gender identity and sexual orientation:

“Covered California continues to make quality health care coverage more accessible and affordable to Californians of all ages, religions, abilities, sexual orientation, gender identities, races, ethnicities and national origins. We’ve built upon the Affordable Care Act’s landmark market reforms to ensure that no one can be turned away from coverage, and that once enrolled they would have access to affordable, high-quality care.


Regular readers may wonder why I've spent so much time obsessively tracking not just the spread of COVID-19 (as numerous sources have been doing) but specifically the partisan spread of it between so-called "red" vs. "blue" states and even red vs. blue counties.

I've obviously never been shy about sharing my political leanings on this website, but a public health crisis shouldn't be a partisan issue, right?

That's correct: It shouldn't be. Unfortunately, the Trump Administration has decided to make it a partisan issue at every stage of the crisis, and with few exceptions, the rest of the GOP has embraced this at the federal, state and even local levels.

As a result, public health POLICY is being directly influenced and in many cases flat-out mandated by PARTISANSHIP.

In the earlier stages of the pandemic hitting the United States, this could be seen in cases like favoratism being shown in which states the federal government was sending PPE (personal protection equipment) to and which states were being given zilch (or, in some cases, broken ventilators and moldy N-95 masks).

Not terribly surprising news; via the Maryland Health Benefit Exchange:


  • More than 43,000 have enrolled since mid-March

The Maryland Health Benefit Exchange announced today that it has extended the deadline of its Coronavirus Emergency Special Enrollment Period so that uninsured residents will have until July 15 to enroll in health coverage through Maryland Health Connection, the state’s health insurance marketplace.

The deadline extension comes as more than 43,000 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.

Regular readers may have noticed that after a 3-4 month hiatus, I've recently started writing several stories touting "ACA 2.0"-type bills again over the past week or so.

First, last Tuesday, I dusted off my "How much would H.R. 1868 lower YOUR premiums?" series, in which I look at real-world examples of the impact of killing the ACA subsidy cliff (i.e. the 400% FPL income eligibility threshold) and beefing up the underlying subsidy formula in specific parts of the country. Then, on Monday, I wrote an updated explainer of a newer bill, H.R. 6545, an Age-Based subsidy enhancer, which I'm touting as a perfect companion bill to go alongside H.R. 1868.

As regular readers know, for the past month or so I've been devoting way too much time to tracking COVID-19 cases & fatalities at the state and county level. For my sources, it's been a combination of state health department websites, the New York Times daily GitHub data archive, the Johns Hopkins University daily GitHub data archive and the WorldoMeter website...which in turn gets their data from other sources. The testing data on my state-level spreadsheet, meanwhile, comes from the COVID Tracking Project website.

For the most part, however, I've settled on WorldoMeter for the state-level data and Johns Hopkins U for the county-level data, as each source formats their data in the most convenient manner for my purposes in porting it to my spreadsheets.

Back in April, I noted that the DC Health Link ACA exchange had announced what appeared to be a special enrollment period specifically intended for employees of small businesses via the ACA's SHOP program, through September 15th, 2020:

DC Health Link Expands Opportunities to Get Covered During Public Health Emergency

Monday, April 6, 2020

Responding to COVID-19 pandemic, DC Health Link permits uninsured employees of DC small businesses that offer health insurance through DC Health Link to get covered now

Note: This is a guest post by Miranda Wilgus, Executive Director and Co-Founder of ACA Consumer Advocacy (disclosure: I'm on the ACACA board of directors).

In the middle of June 2020, with over three months of an international pandemic behind us, over 100,000 Americans and more around the world dead from Covid19 and its complications, what are we waiting for? We know that our administration has done everything possible to impede the facilitation of needs and resources to our country. Special interests are running rampant, price gouging is the norm, government agencies have been scooping up supplies from states that are desperately needed, and the GOP controlled Senate is more focused on packing courts with unqualified idealogues than with passing bills to assist Americans financially affected by the pandemic.

On March 20th, the Vermont Health Connect ACA exchange joined other state-based exchanges in launching a formal COVID-19 Special Enrollment Period.

On April 15th, just ahead of the original SEP deadline, they bumped it out by a month:

Due to the COVID-19 emergency, Vermont Health Connect has opened a Special Enrollment Period until May 15, 2020. During this time, any uninsured Vermonter can sign up for a Qualified Health Plan through Vermont Health Connect. Qualified families can also get financial help paying for coverage.. Please call us at 1-855-899-9600 to learn more.

Then, with the May deadline approaching, I took a look and sure enough, they've bumped it out another month:

On March 16th, New York's ACA exchange, NY State of Health, announced that they'd be launching a COVID-19 Special Enrollment Period with a deadline of April 15th. As that date approached, in the middle of the worst pandemic to hit New York State 100 years, the deadline was extended out by a month, through May 15th.

When that deadline approached, NY Governor Andrew Cuomo ordered the COVID-19 SEP to be bumped out by another month.

And now, with the June 15th deadline having come and gone, lo and behold:

Governor Andrew M. Cuomo today announced low-risk youth sports for regions in phase three of reopening can begin on July 6th with up to two spectators allowed per child. 

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: