Get Covered 2021!


Nearly every state (+DC) has re-opened enrollment on their respective ACA exchanges in response to both the ongoing COVID-19 pandemic and the American Rescue Plan (ARP), which substantially expands and enhances premium subsidies to millions of people!

If you've never enrolled in an ACA healthcare policy before, or if you looked into it years ago but weren't impressed, please give it another shot now. Thanks to the ARP (and some other reasons), it's a whole different ballgame this spring & summer.

Here's 10 important things to understand when you #GetCovered:

Vermont Health Connect

Huh. Vermont's ACA exchange website, Vermont Health Connect, has looked pretty much the same for at least the past 5-6 years, but a month or so ago they quietly overhauled the layout & design interface of the site. I have no idea if they actually updated the back-end, however.

In any event, the VT Health Connect's COVID-19 Special Enrollment Period was originally supposed to end last Friday (May 14th), but they appear to have done something else without much fanfare as well:

COVID-19 Icon

 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.

NOTE: I've recently updated the spreadsheet to account for the official 2020 Census Bureau populations of every state. In most cases this has nudged their case & mortality rates down slightly.

Nearly 1 out of every 7 residents of North Dakota, South Dakota and Rhode Island have tested positive for COVID-19 to date.

More than 1 out of every 8 residents of Iowa.

More than 1 out of every 9 residents of Tennessee, Utah, Arizona, South Carolina, Oklahoma, Nebraska and Arkansas.

More than 1 out of 10 in New Jersey, Indiana, Delaware, Alabama, Illinois, Florida, Mississippi, Kansas, New York, Minnesota, Georgia, Idaho, Nevada, Wisconsin, Wyoming, Montana, Texas and Kentucky.

More than 1 out of 20 in every state & territory EXCEPT Guam, Maine, Oregon, Vermont, U.S. Virgin Islands, Hawaii, N. Mariana Islands & American Samoa.

COVID-19 Vaccine

The vaccination levels for each state below are based on taking the total number of COVID-19 doses administered to date according to the Centers for Disease Control), then dividing half of that (since each person needs two doses to be fully vaccinated) into the total state population as of April 2020 according to the U.S. Census Bureau.

I then adjust each state by adding around 3.5% to account for the single-dose Johnson & Johnson vaccine (J&J makes up around 3.5% of all vaccinations nationally as of today, but not every state seems to break it out, so I'm using the national average for each of them...if I find the exact number/percent per state I'll use that in the future).

The percent of 2020 Presidential election vote won by Donald Trump comes from Wikipedia, which in turn gets their data from the Federal Election Commission.


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.


  • Every county except those in Alaska lists the 2020 Biden/Trump partisan lean; Alaska still uses the 2016 Clinton/Trump results (the 2020 Alaska results are only available by state legislative district, not by county/borough for some reason...if anyone has that info let me know)
  • 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 those caveats in mind, here's the top 100 counties ranked by per capita COVID-19 cases as of Friday, May 14h, 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 (Biden or Trump won by less than 6 points)

I haven't really been following the saga of Colorado's H.B. 1232 "Standardized Health Benefit Plan Colorado Option" bill as much as I should have been over the past year. The last time I wrote anything substantive about it was over a year fact, it was just a few weeks before the COVID hit the fan:

  • The issuers will offer the plans on and off the Exchange in the individual market.
  • The issuers will offer qualified health plans (QHPs) at Bronze, Silver, and Gold metal tiers.
  • The premiums of the plans will reflect facility reimbursement levels that vary by facility. The formula for determining facility-specific reimbursement levels was provided by DOI, utilizing hospital specific financial information provided by HCPF. Maximum reimbursement levels by facility are set between 155% and 218% of Medicare payment rates.
  • The plans will be offered beginning in calendar year 2022.
  • The state intends to apply for a 1332 waiver and use Federal pass-through savings for additional benefits or expanded coverage. The Baseline scenario presented below reflects the current federal and state regulatory market, including a state-based reinsurance program. The second scenario reflects the results of offering a Colorado Health Insurance Option with additional benefits, a premium wrap and a cost-sharing wrap.

So, the Centers for Disease Control (CDC) issued some pretty big news yesterday:

Federal health officials on Thursday advised Americans who are fully vaccinated against the coronavirus that they could stop wearing masks or maintaining social distance in most settings, the clearest sign yet that the pandemic might be nearing an end in the United States.

The new recommendations from the Centers for Disease Control and Prevention caught state officials and businesses by surprise and raised a host of difficult questions about how the guidelines would be carried out. But the advice came as welcome news to many Americans who were weary of restrictions and traumatized by the past year.

“We have all longed for this moment,” Dr. Rochelle P. Walensky, the C.D.C. director, said at a White House news conference on Thursday. “If you are fully vaccinated, you can start doing the things that you had stopped doing because of the pandemic.”

It's important to note that "in most settings" caveat:

One Chance

UPDATE 5/17/21: (sigh) Never mind...again. There were several decisions announced this morning but the ACA case wasn't among them...again. The Sword of Damocles continues to dangle.

The current session of the Supreme Court of the United States runs through the end of June.

This means that unless they decide to punt until the next session, a final SCOTUS decision on the insane, absurd, inane GOP-brought, GOP-supported “Texas Fold’em” lawsuit to strike down the entire Patient Protection & Affordable Care Act will happen within the next 50 days.

As it happens, this just went up an hour ago:

Supreme Court sets Monday as an opinion day. Obamacare, Philly foster-care and Fannie-Freddie all in the potential mix, starting at 10.

— Greg Stohr (@GregStohr) May 13, 2021

This doesn't guarantee that the ACA lawsuit will be announced on Monday...but every day which it isn't announced increases the odds that it will be on the next opinion issuance day.



Last December, after years of failed attempts and controversy, Congress finally passed a bill which, once implemented, is supposed to mostly eliminate one of the uglier problems with our healthcare system: Surprise Bills:

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

Surprise bills happen when an out-of-network provider is unexpectedly involved in a patient’s care. Patients go to a hospital that accepts their insurance, for example, but get treated there by an emergency room physician who doesn’t. Such doctors often bill those patients for large fees, far higher than what health plans typically pay.

HHS Sec. Xavier Becerra

via Amy Lotven of Inside Health Policy:

Becerra Pressed On Surprise Billing, Short-Term Plans, Medicare

Lawmakers from both parties pressed HHS Secretary Xavier Becerra over surprise billing implementation, Medicare policy and non-ACA-compliant plans, including the Trump-era short-term plans and Association Health Plans during a wide-ranging hearing on the department’s fiscal 2022 discretionary budget. The former congressman and California attorney general also assured GOP lawmakers that Medicare for All is not on the agenda.

...The House Progressive Caucus has called for the potential $456 billion in savings to be used to add benefits to Medicare, although the caucus also supports making permanent the ACA’s enhanced tax credits. The White House also made clear that it wants the ACA tax credits to remain.