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.

via MNsure (this was actually posted a couple of weeks ago but I missed it):

ST. PAUL, Minn.—99,688 Minnesotans have come to and enrolled in private health insurance through a special enrollment period (SEP) or received eligibility for a public assistance program (Medical Assistance or MinnesotaCare) since March 1. As expected, sign-ups across all programs have been driven by concerns amid the pandemic.

"It’s never been more important to know you’re covered. That’s why we are so glad to have been able to help almost 100,000 Minnesotans gain access to comprehensive health care coverage," said CEO Nate Clark. "But we know there are others out there who are currently uninsured and may qualify to sign up. If you’ve recently lost your employer-sponsored health insurance, had an income change, or have another qualifying life event, come to to see if you’re eligible."

Hawaii only has two carriers participating in the Individual health insurance market. For 2020, they're reducing unsubsidized premiums by 1.7%

COVID-19 isn't listed as a factor at all by either of the carriers, nor by any of the small group carriers in Hawaii either...which makes total sense since Hawaii has the lowest rate of COVID-19 infection in the country.

The small group carriers are requesting a weighted average reduction of 2% as well, although one of the four doesn't have their actual rate change or current enrollment available yet, so this could change.

So far, only 8 states (+DC) have released their preliminary 2020 ACA-compliant individual market premium rate filings. So what's the deal with the other 42 states? Well, here's a handy 2020 Submission Deadline table from SERFF (the System for Electronic Rates & Forms Filing, a database maintained by the National Association of Insurance Commissioners).

However, it's a bit overly cumbersome: It stretches out over 5 full pages, and includes columns for Standalone Dental Plans as well as a bunch of info regarding the Small Group Market.

To that end, I've cleaned up/simplified the 2021 Submission Deadline table considerably to only include the individual and small group market dates. I'll be perfectly honest: I'm not quite sure what the distinction is between the "Form/Rate Filings" and the "Binder Deadlines", but the dates tend to match up pretty closely, so I've included all of them below.

The graph below is a linear depiction of how COVID-19 has spread across the state of Florida every day since March 20th.

As you can see, the thick orange line shows the ramping up of testing, the thick blue line is the increase in cases and the thick red line is the (official) rate of fatalities. In order to fit all three measurements on the same graph in a presentable way, the scale is different for each: Tests are per 100 residents; cases are per thousand, and deaths are per ten thousand.

The thinner lines are for Orange County, Florida specifically...and there's a reason for that which I'll explain below.


A rational person might be wondering why the Trump Administration and the entire Republican Party* is still dead set on tearing down the entire Affordable Care Act over ten years after it was signed into law, even in the middle of a global pandemic which has already killed more than 130,000 Americans and infected nearly 3 million more.

After all, they were eventually able to eliminate the single least popular provision of the law: The federal individual mandate penalty. Most of the rest of the elements are actually quite popular...and in fact poll after poll finds that the bulk of the public wants those other provisions strengthened, not weakened or eliminated.

IMPORTANT UPDATE: I've been alerted to the fact that I had data entry errors in at least two of the states last weekend (Michigan and Texas). It looks like the sort order got messed up during the data transfer in those states. As a result, at least 2 of the "Top 40" / "Top 100" counties I had listed were wrong. I've deleted the spreadsheets for this week and will triple-check everything for this weekend's weekly update. My apologies for the error.


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:

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:

New Mexico is the latest state to post their preliminary 2021 rate change filings for both the individual and small group markets. There's several key things to note here:

Michigan is the 8th state (by my count) where the insurance carriers have posted their preliminary 2021 premium rate change filings. Every year brings some new twist (in 2018 it was CSR reimbursement payments being cut off; in 2019 it was the zeroing out of the ACA's federal individual mandate penalty; in 2020 it was sort of the repeal of the ACA's health insurer tax (HIT), although that didn't actually happen until after 2020 premiums had already been locked in; and for's the COVID-19 pandemic, of course.

I've therefore added a new column for my weighted average rate change spreadsheets. So far only a handful of carriers have tacked on any substantial rate changes due to expected cost increases from testing & treatment of COVID-19 next year...the general rule of thumb seems to be that the added costs are pretty much gonna be cancelled out by reduced claims from non-COVID healthcare services (delayed/cancelled treatments/procedures, etc).