As I noted right after the November election, along with all the other vitally important things which would change if Jon Ossoff & Rev. Raphael Warnock flipped both Georgia Senate seats is this: It would give Congressional Democrats the opportunity to #MootTheSuit.

The federal lawsuit to strike down the entire Affordable Care Act was heard by the U.S. Supreme Court on Tuesday, November 10th.

As I've written about several times, while the hearing happened on 11/10, the actual decision in the case isn't expected to be announced until sometime this spring (likely April or later).

The official 2021 ACA Open Enrollment Period deadline passed at midnight on December 15th in most states, but many state-based ACA exchanges have later deadlines, so residents of those states still have time to #GetCovered with #ACA-compliant healthcare coverage!

Here's a list of important things to remember when selecting a health insurance policy. Some of these are the same every year and apply nationwide; others are specific to the 2021 enrollment period and/or to particular states.

1. DON'T MISS THE DEADLINE!

Access Health CT, Connecticut's state-based ACA exchange, has updated their enrollment summary and now reports 104,946 residents have selected policies for 2021, including 19,056 new enrollees.

Last year they had a total of 107,833 QHP selections during Open Enrollment, so they end the 2021 Open Enrollment Period down 2.7% year over year.

There's no formal press release, so this total might not be official but it should be pretty close.

via Connect for Health Colorado (by email):

Nearly 180,000 Coloradans Signed Up for Health Insurance through the Marketplace 

DENVER – 179,661 Coloradans signed up for a health insurance plan by the end of the Open Enrollment period, according to preliminary data released today by Connect for Health Colorado®. This is about 8 percent above last year’s end of Open Enrollment total. 69% of the customers who enrolled in a 2021 plan qualified for financial help to reduce their monthly premium. 

“I’m pleased that so many people took advantage of this year’s enrollment period,” said Chief Executive Officer Kevin Patterson. “It’s essential that we all have health coverage in place to protect ourselves and our families this year.” 

Outside of the Open Enrollment period, Coloradans can still sign up for a health insurance plan through the Marketplace if they experience a Qualified Life Event, like losing job-based insurance, losing Health First Colorado (Medicaid) coverage or due to certain family and income changes. Residents can continue to get help signing up for coverage from certified Brokers and community-based Assisters. 

Over at Vox yesterday, Dylan Scott wrote a piece titled "The Trump presidency is over, and Obamacare is still alive" which is worth a read.

Before November 8th, 2016, I was secretly planning on shutting down (or at least mothballing) ACA Signups as soon as the 4th Open Enrollment period was over. Traffic had been gradually dropping off as people got used to the ACA & it started to fade from the headlines. My official day job as a website developer had suffered. What was supposed to have been a 6-month hobby in my spare time had turned into a full-time job, and I had lost web clients along the way. I figured it would be time to wind down ACA Signups & refocus on my web business.

nstead...well, you know what happened. On November 9th, 2016, I changed the header to this graphic, assuming that the ACA was doomed. I even registered ACASignoffs.net and redirected it to the site. I intended to keep the revised header up for 24 hours as a symbolic gesture.

Note: This is the second or third time that I'm cribbing a bit from my friend & colleague Andrew Sprung over at Xpostfactoid. If you like my healthcare policy analysis/writing style and follow me on Twitter, you should follow him at @xpostfactoid as well.

Over at Xpostfactoid, Andrew Sprung beat me to the punch by several days with an excellent two-part look at the "ACA 2.0 Hunger Games" scenario.

During the Democratic primary season, I posted a simple graph which boiled down the four major types of healthcare policy overhaul favored by the various Democratic Presidential candidates...which also largely cover the gamut of systems preferred by various Democratic members of the House and Senate.

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.

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:

  • Every county except those in Alaska lists the 2020 Biden/Trump partisan lean; Alaska still uses the 2016 Clinton/Trump results. I define a "Swing District" as one where the difference between Biden & Trump was less than 6.0%. FWIW, there's just 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.
  • For the U.S. territories, Puerto Rico only includes the case breakout, not deaths, which are unavailable by county equivalent for some reason.

With these updates in mind, here's the top 100 counties ranked by per capita COVID-19 cases as of Friday, January 15th, 2021 (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

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

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. For cases per capita, 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, although things are getting pretty horrible everywhere now.

North Dakota has broken 12.5% of the entire population having tested positive, or over 1 out of every 8 residents.

South Dakota is up to 11.9%, or more than 1 out of every 9 residents.

Utah, Tennessee, Rhode Island and Iowa are on the verge of passing 1 out of every 10 residents.

34 states have seen at least 1 out of every 15 residents test positive.

via Get Covered NJ:

As Open Enrollment Deadline Nears, Residents Urged to Sign Up for Health Insurance at Get Covered New Jersey

  • ​8 in 10 Qualify For Financial Help to Lower Costs

TRENTON – As the Open Enrollment deadline nears, Governor Phil Murphy, Department of Banking and Insurance Commissioner Marlene Caride, and state legislators today urged residents in need of health insurance for 2021 to sign up for a plan at Get Covered New Jersey.

Open enrollment for the state’s official health insurance marketplace, Get Covered New Jersey ends January 31, 2021. Commissioner Caride reminded New Jerseyans that open enrollment is the only time during the year when residents can enroll in coverage, unless they have a major life event that qualifies them for a Special Enrollment Period or they qualify for NJ FamilyCare. With nearly two weeks left in open enrollment, now is the time to visit Get Covered New Jersey to shop for quality, affordable health insurance and to enroll in a plan by the January 31, 2021 deadline.

via the Washington Health Benefit Exchange:

2021 Open Enrollment for Health Coverage Ends This Friday

  • Act before midnight, Jan. 15, to secure health insurance for this year

Washington Healthplanfinder is alerting all Washingtonians still seeking health insurance that they have until midnight, Jan. 15, to select a health and dental plan for the upcoming 2021 plan year. Coverage for those who enroll before the deadline will start Feb. 1.

“This is the last call for any individuals and families who have not signed up for a health and dental plan,” said Chief Executive Officer Pam MacEwan. “With only a few hours remaining before the deadline, people that still need 2021 coverage should sign up before it is too late.”

via Your Health Idaho:

More than 79,000 Idahoans Enroll in 2021 Health Insurance Coverage

BOISE, Idaho – More than 79,000 Idahoans signed up for 2021 health insurance coverage through the state health insurance exchange, Your Health Idaho, during the annual open enrollment period.

Compared to the same time last year, enrollments on the exchange are down by approximately 10,000. This decline is attributed in large part to the ongoing impacts of the COVID-19 pandemic and resulting public health emergencies and protected coverage policies.  

Last year's official Idaho Open Enrollment Period (OEP) Qualified Health Plan (QHP) total was 78,431, so 79,000 should be slightly higher, not 10,000 lower. What's going on here?

As I noted a year and a half ago in my analysis of Joe Biden's healthcare policy proposal, two major chunks of his plan are taken straight out of the House Democrats ACA 2.0 bills from 2018 & 2019 and from the Elizabeth Warren's ACA 2.0 bill in the Senate (CHIP, or the Consumer Health Insurance Protection Act). In fact, these two particular proposals were even part of Hillary Clinton's 2016 health plan, and originated way back in 2015 under a proposal by the Urban Institute:

Regular readers (and some non-regular readers) may recall that in the week between Christmas and New Year's Eve, I put out an urgent "call to action" request for people to submit Public Comment on the proposed annual Notice of Benefit & Payment Parameters for 2022 (NBPP) rule.

As I explained, every year, the Centers for Medicare & Medicaid (CMS) puts together a bunch of proposed modifications to the implementation details of the ACA. Some are simple clarifications of existing procedures; some are minor tweaks; and some are major changes. Of the major changes, some are positive...and some are negative. In the case of the 2022 NBPP, there are examples of all three...and the major changes are really major. As in, ranging from harmful to likely flat-out illegal.

For 2022, there were several NBPP items which seem either innocuous or are actually good ideas...but there are a couple of pretty questionable ones and a few more which would be outright devastating (there are also a few involving things like Risk Adjustment which I'm not familiar enough with to comment on one way or the other).

via MNsure:

ST. PAUL, Minn.—The Minnesota Insulin Safety Net Program was created to help Minnesotans who face difficulty affording their insulin. The program is made up of two parts: the urgent need program and the continuing need program.

  • The urgent need program—eligible Minnesotans can receive a 30-day supply of insulin immediately at their pharmacy for no more than $35.
  • The The continuing need program—eligible Minnesotans can receive up to a year supply of insulin for no more than $50 per 90-day refill.

To be eligible for the urgent need program, you must—

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