The federal lawsuit to strike down the entire Affordable Care Act was heard by the U.S. Supreme Court last November, a week after the election.

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).

8. UPDATE 2/9/21: IMPORTANT! Assuming the just-released House Ways & Means Committee COVID Relief Bill ends up passing as part of the final American Rescue Plan as currently written, it would include major expansion of and enhancements to ACA subsidies. Just as importantly, the subsidy improvements would be retroactive to the beginning of this year.

This means that millions of Americans earning more than 400% of the Federal Poverty Line would be eligible for ACA subsidies for the first time ever, NOW (and millions of current enrollees already receiving subsidies would see them enhanced).

(I'm adding this 8th item before the other 7 because if it goes through it'll be a pretty big game changer.)

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.

via MNsure:

Last Chance for March 1 Coverage Through MNsure; Special Enrollment Period Continues Through May 17

February 24, 2021

ST. PAUL, Minn.—Minnesotans looking for private health insurance coverage through MNsure that begins on March 1 need to enroll by 11:59 p.m. on Sunday, February 28. Plans selected in March will have an effective date of April 1. MNsure's special enrollment period continues through Monday, May 17, and is available to any Minnesotan who is uninsured or who is not currently enrolled in a qualified health plan through MNsure.

“If you’re looking for health insurance coverage, be sure to check out your options at MNsure.org and get access to comprehensive coverage as soon as possible or prevent a gap in current coverage,” said MNsure CEO Nate Clark. “MNsure's special enrollment period continues through May 17, but Sunday, February 28, is your last chance to get coverage starting in March. Don’t miss out."

Instructions to enroll and frequently asked questions about this special enrollment period can be found here.

Help is available:

Disclosure: Health Sherpa is a paid sponsor of this site.

Back in January, before the ongoing COVID Enrollment Period was officially announced, I ran some back-of-the-envelope math to try and project just how many additional ACA exchange enrollees might sign up nationally due to the addition of a "no questions asked" Special Enrollment Period (SEP) being formally launched across every state, as opposed to the patchwork of COVID SEPs we saw across a dozen states last spring/summer.

I extrapolated those numbers out nationally and estimated that total on-exchange enrollment might increase by perhaps 400,000 more people thanks to a 60-day COVID SEP...that is, 400K more than the "normal" number who typically enroll during that same time period for traditional SEP reasons (losing employer coverage, turning 26, getting married/divorced, moving, giving birth/adopting, etc).

Much has been written by myself and others (especially the Kaiser Family Foundation) about the fact that millions of uninsured Americans are eligible for ZERO PREMIUM Bronze ACA healthcare policies.

I say "Zero Premium" instead of "Free" because there's still deductibles and co-pays involved, although all ACA plans also include a long list of free preventative services from physicals and blood screenings to mammograms and immunizations with no deductible or co-pay involved.

If you have a fairly healthy year, you really could go the entire year without paying a dime in healthcare costs while still taking advantage of many of these free services, and also having the peace of mind that in a worst-case scenario, at least you wouldn't go bankrupt. Not ideal, but a lot better than going bare.

 CMS Offers Comprehensive Support to the State of Texas to Combat Winter Storm 

The Centers for Medicare & Medicaid Services (CMS) announced today that efforts are underway to support Texas in response to severe winter storms that have affected the state over the past several days.  On February 17, 2021, Health and Human Services Acting Secretary Norris Cochran declared a public health emergency (PHE) for Texas retroactive to February 11, 2021. CMS is working to ensure hospitals and other facilities can continue operations and provide access to care despite the effects of the storm. 

Below are key administrative actions CMS is taking in response to the PHE declared in Texas:

Waivers and Flexibilities for Hospitals and other Healthcare Facilities: CMS has already waived many Medicare, Medicaid and CHIP requirements for facilities because of the pandemic. 

Millions of Americans are nervously awaiting the official ruling on the fate of the Affordable Care Act in response to the CA v. TX lawsuit (previously Texas vs. U.S. or Texas vs. Azar, though I've given it the hashtag #TexasFoldEm due to the Trump Administration's Justice Department deciding to not only throw the fight but to actively support the plaintiffs against the law of the land).

While the U.S. Supreme Court isn't expected to issue their decision until April at the earliest, it's possible that they'll publish their ruling earlier than that...potentially as soon as this Thursday morning, February 25th.

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 187 swing districts (out of over 3,100 total), with around 33.7 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, February 19th, 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.

1 out of every 8 residents of North & South Dakota's entire populations have tested positive for COVID-19 over the past year.

Rhode Island is up to over 1 out of every 9 residents.

Utah, Tennessee, Arizona, Iowa, Oklahoma and Arkansas, Nebraska and Kansas are up to 1 out of every 10 residents.

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

EVERY state except Washington, Oregon, Maine, Hawaii & Vermont (along with 4 U.S. territories) have now surpassed 1 out of every 20 residents having tested positive.

President Biden's nominee to run the Centers for Medicare & Medicaid Services (CMS) has been a hotly-debated topic among healthcare wonks for a couple of months now. He announced that he was picking California Attorney General Xavier Becerra as his HHS Secretary back in early December, but who would be running CMS (basically the 2nd most-powerful position within the HHS Dept.) has been a big unknown until a few days ago, when Dan Diamond and Amy Goldstein of the Washington Post scooped the story.

I admit to never having heard of her until her name was mentioned as a possible contender in a few articles last month, but if confirmed, I'll probably be mentioning her name fairly often over the next few years (likely even more frequently than Becerras), so I figured I should post a quick profile of her today.

Here's the official White House statement:

 

Over at the Journal of Healthcare Finance, David Anderson, Sih-Ting Cai and Jean Marie Abraham have published an interesting idea which I've never thought about before:

In 2019, CMS (2020b) began publishing its Quality Rating System (QRS) for incumbent insurers who sell qualified health plans in the individual market. This information includes scores for medical care, member experience, and plan administration which are then rolled up into an overall, global quality rating (GQR). Recent research has shown notable variation by plan characteristics for behavioral health quality (Abraham, et al., 2021) and plan administration scores (Anderson, et al., 2020). CMS hopes this information is used by consumers to make enrollment decisions.

While all 50 states & DC have now re-launched (or are about to) a new, special 2021 COVID Enrollment Period, the official 2021 Open Enrollment Period ended in every state as of January 31st.

A few of the state-based exchanges have already released their 2021 OEP summary reports, and today Access Health CT posted theirs...and it's chock full of juicy data nuggets. Let's dive in!

Note: I haven't included every single slide, but most of them are shown. Use the link above if you want to view the rest of them. Click the images for a high-res version of each:

via Pennie, Pennsylvania's new state-based ACA exchange:

Pennie Opens a COVID-19 Enrollment Period Which Will Run Until May 15

  • Uninsured Pennsylvanians or those affected by COVID-19 can visit pennie.comand enroll in a plan through May 15.  

 Harrisburg, PA – February 17, 2021 – Uninsured Pennsylvanians can act now and enroll in 2021 coverage during Pennie’s COVID-19 Enrollment Period. Pennie, Pennsylvania’s state-based health insurance marketplace, is proud to provide individuals across the Commonwealth additional time to enroll in health insurance to protect them and their families from the cost of the COVID-19 virus. This enrollment period is in-line with President Biden’s recent Executive Order and is open for all Pennsylvanians who have been impacted by COVID-19. Anyone otherwise eligible to enroll in coverage through Pennie™ can do so from now until May 15.

As I've expected, though I'm pretty irritated that they still haven't released any enrollment data to date. Via NY State of Health:

Press Release: Governor Cuomo Announces Open Enrollment for New Yorkers is Extended to May 15 as Federal Marketplace Reopens for Millions of Americans

  • New Yorkers Can Apply Now For Health Coverage Through NY State of Health or Directly Through Insurers
  • Aligns New York with the Federal Marketplace and Numerous State Marketplaces Extending Enrollment

As COVID-19 Response and Vaccine Distribution Continues Statewide, High-Quality Health Insurance More Important Than Ever

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