Last week I wrote about how my friend Laura Packard, along with up to 44,000 others, is in serious danger of losing access to critically important cancer treatment and other services due to a falling out between one of the largest health insurance carriers and one of the largest medical centers in Colorado:

Denver-area Anthem customers on Colorado exchange forced to switch doctors

DENVER (KDVR) — Laura Packard was diagnosed with stage 4 Hodgkins-Lymphoma cancer in 2017. The 44-year-old moved from Nevada to Colorado in 2019 for one reason: the state’s heath insurance exchange that provides affordable options to individuals who otherwise can’t get coverage.

Doctors at UCHealth have continued to treat Packard to make sure she stays cancer-free.

Earlier this evening, U.S. Senator Bernie Sanders of Vermont tweeted this:

Good politics: Over the past decade, every Medicare for All co-sponsor up for re-election beat their Republican opponent – every single one.

Good policy: Medicare for All would save 68,000 lives and cost $650 billion LESS than our current dysfunctional healthcare system a year.

— Bernie Sanders (@BernieSanders) December 22, 2020

I'm not gonna dig back through the past 5 election cycles to verify whether this claim is accurate or not, but I did at least check into it for the most recent election last month.

A reminder from MNsure, Minnesota's ACA exchange:

MNsure's Open Enrollment Period Ends Tuesday, December 22 at Midnight

December 21, 2020

ST. PAUL, Minn.—Minnesotans looking for private health insurance beginning January 1, 2021, have until 11:59 p.m. on Tuesday, December 22 to enroll in coverage through MNsure.

"Don't miss your chance to get health insurance coverage in the new year," said MNsure CEO Nate Clark. "Come to MNsure.org to compare your options and see if you qualify for financial benefits to lower the cost of your insurance—most Minnesotans do! Get enrolled today and have the peace of mind that comes with knowing you’ve got comprehensive health coverage."

MNsure's Contact Center is open from 8 a.m. to 9 p.m. on Monday, December 21 and 8 a.m. to midnight on Tuesday, December 22.

Most people qualify for financial help. Minnesotans can see their estimated eligibility for financial help by using MNsure's plan comparison tool.

I'm over a month late on this, but the DC Health Benefit Exchange Authority issued a mid-OEP enrollment report at their November board meeting (unfortunately they don't appear to have done so at their December meeting), so here it is as of 11/16.

Ther's not a whole lot of interest here, but it's worth noting that DC's effectuated enrollment in November was 7.6% higher than a year ago. This is again likely due to the extended "open" COVID-19 Special Enrollment Period in 2020:

Well, for good or for bad, it's finally here: The stripped-down-but-bipartisan COVID19 relief bill.

You can read the whole thing here...if you have a LOT of spare time on your hands. It's 5,600 pages long, 1.1 million words. For context, the entire Lord of the Rings trilogy is only half that length (576,000 words).

There's 1,000 explainers being written today about the most obvious stuff (the $600 direct relief checks, the extended & enhanced unemployment funding, etc etc), most of which falls far short of what's actually needed. Instead, I'm focusing on the ACA-related provisions. I already wrote about the surprise billing prohibition this morning, of course, but a quick initial scan of the text (which isn't easy...again, 5,600 pages...) reveals several other items directly related to the Affordable Care Act, so let's take a look! (Note: I'm sure I'm missing a few):

Page 4,206:

 

Over six months after House Democrats passed a robust COVID-19 relief bill (only to see it continuously blocked by Republican Senate Majority Leader Mitch McConnell), it looks like Congress is finally set to compromise on a vastly stripped-down bipartisan bill which would provide at least a small amount of relief for hundreds of millions of American families and businesses.

While the bill is underwhelming (to put it mildly) overall, it does include several important provisions, one of which is a long-sought solution to a massive healthcare problem which existed long before COVID came knocking at our door nearly a year ago: Surprise Billing.

Over at the New York Times, Sarah Kliff and Margot Sanger-Katz have written an excellent summary of the problem and the proposed solution:

The data below comes from the GitHub data repositories of Johns Hopkins University, except for Utah, which comes from the GitHub data of the New York Times due to JHU not breaking the state out by county but by "region" for some reason.

I've made some more changes:

  • I've now completed updating the partisan lean for every county except Alaska (I'm having trouble getting that broken out by "County-Equivalent Region") to the 2020 Biden/Trump results. Alaska still uses the Clinton/Trump 2016 results, although I can't imagine more than one or two regions changed status there this year.
  • I've also added columns listing the actual Biden/Trump vote percentage for each county to give a feel for how partisan it is. Again, I'm defining "Swing District" as any county where the difference is less than 6.0%. There's 188 swing districts (out of over 3,100 total), with around 33.8 million Americans out of 332 million total, or roughly 10.2% of the U.S. population.
  • I've also added all U.S. territories, including a county-equivalent breakout for Puerto Rico, as well as American Samoa, Guam and the U.S. Virgin Islands. None of these vote in the general Presidential election, of course, but I'm still tracking their COVID-19 case & death rates. None show up in the top 100 of either ranking, however. Note that Puerto Rico only includes the case breakout, not deaths, which are unavailable for some reason.
  • Finally, I corrected a significant error on my part in the Blue/Red County Ratio graph (see below)

With these updates in mind, here's the top 100 counties ranked by per capita COVID-19 cases as of Friday, December 18th (click image for high-res version).

Blue = Joe Biden won by more than 6 points; Orange = Donald Trump won by more than 6 points; Yellow = Swing District

In my Twitter thread yesterday breaking out the semi-final HC.gov weekly snapshot enrollment report, I noted:

STATE LEVEL:
--25 out of 36 states outperformed last year
--Best % increase y/y: TEXAS (+14.9%)
--Worst $ decrease y/y: KENTUCKY (-6.7%)

I have no idea if there's anything special in either state which caused either to do as well/poorly as they did relative to last year.

My colleagues Colin Baillio and Andrew Sprung took note of this, and Sprung decided to look into it further. He broke out the states between Medicaid expansion and non-expansion states, and voila:

From the state totals one obvious pattern leaps out: enrollment is up 9.7% in states that have not enacted the ACA Medicaid expansion -- and down 0.5% in states that have expanded the expansion (including Nebraska, which opened the Medicaid expansion doors in October of this year).

Access Health CT, Connecticut's state-based ACA exchange, has updated their enrollment summary and now reports 102,049 residents have selected policies for 2021, including 15,310 new enrollees.

Last year they had a total of 107,833 QHP selections during Open Enrollment, which they're just 5.4% away from breaking.

In addition, as noted a few days ago, they're also extending their deadline by a full month (whcih they also did last year):

via Access Health CT:

Access Health CT Extends 2021 Annual Open Enrollment Period As A Result Of Current Health Crisis

CT residents can shop and enroll in health insurance coverage until January 15, 2021

A picture is worth 1,000 words and all that.

I was doing this earlier in the summer but stopped updating it in August; I've started over with a fresh spreadsheet and have expanded it to include every U.S. territory, including not just DC & Puerto Rico but also American Samoa, Guam, the U.S. Virgin Islands and even the Northern Mariana Islands.

I've done my best to label every state/territory, which obviously isn't easy to do for most of them given how tangled it gets in the middle. The most obvious point is that New York and New Jersey, which towered over every other state last spring, are now utterly dwarfed by North & South Dakota, which are skyrocketing.

North and South Dakota are the first two states where more than 10% of the entire population has tested positive (in fact, North Dakota is about to hit 12%. Iowa, Wisconsin, Nebraska and Utah could all potentially hit the 10% milestone by New Year's Eve as well.

Way back in October 2013, I launched the ACA Signups project as a light, nerdy hobby thing which was only supposed to last around six months, through the end of the first ACA Open Enrollment Period (March 31, 2014). Instead...well, let's just say that it's more than seven years later and I'm still doing this.

The reality is that The Graph itself doesn't serve a whole lot of useful function anymore. The enrollment patterns were erratic the first couple of years but have since settled into a pretty predictable...if not downright boring pattern for both the federal and state exchanges. The main reason I keep doing it each year is mostly out of tradition these days; after all, without The Graph, there wouldn't be an ACA Signups and I wouldn't have become a healthcare policy wonk in the first place.

Hot off the presses, via the Centers for Medicare & Medicaid:

Week Six, December 6 - December 15, 2020

In Week Six of the 2021 Open Enrollment period, 4,416,057 people selected plans using the HealthCare.gov platform or were automatically re-enrolled in a plan. While past snapshots this year have measured enrollment weeks Sunday through Saturday, this week’s snapshot for week six also includes the final few days of the Open Enrollment Period.

Annnnnnd add Your Health Idaho to the list:

Deadline to Get Health Insurance Extended
Idahoans have until December 31 to get covered for 2021

Today, for the first time ever, the Your Health Idaho Board of Directors voted to extend the Open Enrolment deadline. Idahoans now have until Dec. 31, 2020, to sign up for health insurance coverage that begins Jan. 1, 2021.

Your Health Idaho saw the largest single-day enrollment since 2018 on Tuesday, Dec. 15, the original deadline date. This increased activity coupled with ongoing impacts from the coronavirus pandemic spurred Your Health Idaho to extend the deadline.

“An unprecedented year calls for unprecedented measures,” said Your Health Idaho Chairman of the Board, Stephen Weeg. “Given the challenges faced by Idahoans in 2020 and the renewed need for comprehensive health insurance, we hope that by extending the deadline a few more weeks, every Idahoan will have access to the coverage they need for the coming year.”

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