I wasn't really planning on doing another red/blue COVID death rate analysis; the point has been pretty much beaten into the ground by now. However, given how much interest there's been in the impact (or lack thereof) of the red/blue divide on the 2022 midterms, I figured I'd dust off the spreadsheet one more time.
First, a final summary of the actual impact on the midterms:
via the Centers for Medicare & Medicaid Services (CMS), by email:
Today, the Centers for Medicare & Medicaid Services (CMS) released the latest enrollment figures for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). These programs serve as key connectors to care for more millions of Americans.
Medicare
As of August 2022, 64,942,984 people are enrolled in Medicare. This is an increase of 111,278 since the last report.
34,939,872 are enrolled in Original Medicare.
30,003,112 are enrolled in Medicare Advantage or other health plans. This includes enrollment in Medicare Advantage plans with and without prescription drug coverage.
50,443,950 are enrolled in Medicare Part D. This includes enrollment in stand-alone prescription drug plans as well as Medicare Advantage plans that offer prescription drug coverage.
Last week I noted that the Centers for Medicare & Medicaid Services (CMS) finally released their first 2023 Open Enrollment Period report, which included 3.0 million Qualified Health Plan (QHP) enrollees through 11/19/22 for the 33 states hosted by HealthCare.Gov plus another 387,000 QHP enrollees via the 18 state-based ACA exchanges.
In a footnote, the press release also noted that around 1.07 million New Yorkers have enrolled in NY's ACA-created Basic Health Plan (BHP) program, which is designed specifically for people who earn between 138% of the Federal Poverty Level (FPL) (the cut-off for ACA-expanded Medicaid eligibility) and 200% FPL.
Access Health CT Waives Requirement for Certain Small Businesses to Enroll in a Group Health Insurance Plan Through December 15
Small businesses can enroll in group health insurance at any time of year, but they usually need a certain percentage of employees to participate in the plan
HARTFORD, Conn. (Nov. 23, 2022) — Access Health CT (AHCT) Small Business today announced it will waive the minimum number of employees typically required to enroll in a small group health insurance plan now through Dec. 15.
Small businesses can enroll in a group health insurance plan at any time of year. However, they usually need a certain percentage of employees to participate in the plan. During this period, any small business with 50 or fewer employees in Connecticut can enroll in a group health insurance plan regardless of how many employees participate.
Executive Board votes to cut copays to $5, no deductibles
Washington, DC–The DC Health Benefit Exchange Authority (DCHBX) Executive Board unanimously voted to adopt recommendations based on the work of the DCHBX Standard Plans Working Group to help address health disparities in pediatric mental health treatment. Starting in Plan Year 2024, children covered by a standard plan on DC Health Link will only have a $5 copay, with no deductibles, for outpatient mental health visits, including specialist visits, and no limit on the number of visits. Additionally, this vote reduces prescription copays for child mental health care to $5, with no deductibles.
The action taken by DCHBX means that parents who had copays as high as $45 for their children's mental health visits will only pay $5 starting in 2024. Additionally, parents who were paying as high as $25 in copays for even the lowest-cost generic prescriptions for their children, will have only a $5 copay starting in 2024.
New Yorkers Enrolling by December 15 will be Covered on January 1
ALBANY, N.Y. (November 23, 2022) – NY State of Health, the state's official health plan Marketplace, is working with food pantries for the sixth consecutive holiday season to help consumers access high-quality, affordable health insurance for the upcoming year. Certified enrollment specialists will be available at food pantries across the state during November and December to provide consumers with enrollment assistance. Consumers must enroll by December 15, 2022, for health coverage starting January 1, 2023.
Completed applications/ redeterminations processed through the integrated eligibility system: 8,128
I've never been entirely sure what the "Acquisition Summary" figure refers to, but I've confirmed that it's already included in the larger number.
It looks like Access Health CT has gone ahead and added their "front-loaded" auto-renewal enrollment in this update after several weeks of not doing so.
One of the most inane restrictions of the ACA in my view, as I noted in my "If I Ran the Zoo" wish list back in 2017, is that it doesn't allow undocumented immigrants to enroll in ACA marketplace health plans ("Qualified Health Plans" or QHPs).
I don't just mean that they aren't eligible for federal financial subsidies--that's a prohibition which I can at least understand, even if I don't agree with it. I mean that they aren't allowed to enroll in ACA exchange-based QHPs even at full price, as noted in Section 1312(f)(3):
(3) Access limited to lawful residents.--If an individual is not, or is not reasonably expected to be for the entire period for which enrollment is sought, a citizen or national of the United States or an alien lawfully present in the United States, the individual shall not be treated as a qualified individual and may not be covered under a qualified health plan in the individual market that is offered through an Exchange.
Usually during the annual ACA Open Enrollment Period, the Centers for Medicare & Medicaid Services issue weekly "snapshot" reports of how enrollment is going via the federal ACA exchange (HealthCare.Gov).
Biden-Harris Administration Announces Nearly 40% Increase in New Sign-Ups on HealthCare.Gov
Today, during his remarks on lowering costs for American families, President Biden announced that the number of new enrollees who have signed up for high-quality, affordable health insurance on HealthCare.Gov is up almost 40% compared to the same time last year.
...HHS will release the first formal report on Open Enrollment data next Tuesday, November 22.
You'd assume that DC's governing body would be a staunch supporter of both the letter and spirit of the Affordable Care Act, and for the most part you'd be correct.
And yet, somehow, in this liberal bastion, there's a decidedly anti-Patient Protection, anti-Affordable Care bill which has somehow managed to work its way into the Council's legislative proceedings.
The Centers for Medicare & Medicaid Services (CMS) announced today that the first improper payment rate for the Federally-facilitated Exchange (FFE) program was less than 1% for Benefit Year 2020, thanks in large part to the agency’s implementation of effective automated processes for the program’s eligibility determinations and payments. This finding highlights CMS’ commitment to being responsible stewards of public funds, and to ensuring the sustainability of its programs for future generations.
Improper payments are payments that do not meet CMS program requirements. These can be overpayments or underpayments, or payments where insufficient information was provided to determine whether a payment was proper. Most improper payments involve situations where a state or provider missed an administrative step. The vast majority of improper payments are not fraud, and improper payment estimates are not fraud rate estimates.
ROCHESTER, Minn.—Individuals and families in southeastern Minnesota are poised to save hundreds of dollars on monthly premiums next year when they purchase health coverage and take advantage of premium tax credits only available through MNsure. At a press conference in Rochester today, MNsure CEO Nate Clark shared the news that tax credits in southeastern Minnesota are going up by $120/month, on average, in 2023 for eligible households in the 10-county area including Dodge, Fillmore, Freeborn, Goodhue, Houston, Mower, Olmsted, Steele, Wabasha and Winona counties.
On average, eligible households in southeastern Minnesota are projected to save $860/month, or about $10,320/year, thanks to the larger tax credits in 2023. In other words, eligible Minnesotans will pay about 10% less on premiums next year than they pay currently, and that can mean big savings for the small business owners, gig workers, farmers and other Minnesotans that MNsure serves.
The Maine Department of Health and Human Services (DHHS) Office of the Health Insurance Marketplace (OHIM) will release biweekly updates on plan selections through CoverME.gov, Maine’s Health Insurance Marketplace.
Plan selections provide a snapshot of activity by new and returning consumers who have selected a plan for 2023. “Plan selections” become “enrollments” once consumers have paid their first monthly premium to begin insurance. These numbers are subject to change as consumers may modify or cancel plans after their initial selection.
The deadline to select a plan for coverage beginning January 1, 2023 is December 15, 2022. Consumers who select a plan after that date will have coverage beginning February 1, 2023.
via the Health & Human Services Dept. (via email, no link yet):
Biden-Harris Administration Announces Nearly 40% Increase in New Sign-Ups on HealthCare.Gov
Today, during his remarks on lowering costs for American families, President Biden announced that the number of new enrollees who have signed up for high-quality, affordable health insurance on HealthCare.Gov is up almost 40% compared to the same time last year. U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra released the following statement on today’s Open Enrollment announcement:
“We are off to a strong start - and we will not rest until we can connect everyone possible to health care coverage this enrollment season. The Biden-Harris Administration has taken historic action to expand access to health care, and ensure everyone can have the peace of mind that comes with being insured. With four out of five people eligible for coverage at $10 or less, do not miss your opportunity to sign up for high-quality, affordable health care. We urge everyone to visit HealthCare.gov and find the coverage that meets your needs.”
This report provides a summary of information for week one of the beWellnm health insurance individual Marketplace Open Enrollment Period for plan year 2023 (OEP 2023). The report contains data from the beWellnm eligibility and enrollment platform for OEP 2023, and includes an overview of the following:
plan selections
new enrollees
enrollees renewing coverage
Customer Engagement Center call volumes
website traffic
Enrollment
This section contains enrollment data through November 5, 2022.
1. Total Plan Selections (net): Count of unique individuals who have selected a Plan Year (PY) 2023 Marketplace medical plan. Count includes all new and re-enrolling consumers (defined in Indicators 2 and 3), regardless of whether the consumer has paid the first month premium. Count does not include plans that were canceled or terminated.: 33,367
Completed applications/redeterminations processed through the integrated eligibility system: 6,425
I've never been entirely sure what the "Acquisition Summary" figure refers to, but I've confirmed that it's already included in the larger number.
One minor note: For the past few years, Access Health CT has "front-loaded" their OEP enrollment reports...that is, they auto-renewed all existing enrollees up front, including them in their weekly enrollment numbers, and then reduced the total as current enrollees terminated their renewals. I'm not sure why they're going back to not including them.
Doesn't matte either way; the final enrollment total will be the same either way. Just interesting to a handful of data geeks like myself.
Enhanced Federal Subsidies Will Continue to Lower Monthly Premiums for New Yorkers to Lowest Levels in Recent Years
Certified Enrollment Assistors Available Across the State to Offer Free Enrollment Guidance, Plan Comparisons, and Cost Estimates
ALBANY, NY. (November 16, 2022) – NY State of Health, the State’s official health plan Marketplace, today announced the launch of the 2023 open enrollment period for New Yorkers seeking a consumer-oriented, one-stop shopping experience for public and commercial health insurance. Consumers can begin enrolling or renewing today, November 16, and have until December 15, 2022, to complete their enrollment into a quality, low-cost Qualified Health Plan (QHP), with coverage starting on January 1, 2023.
Speaker of the House Nancy Pelosi, the first woman to hold the most powerful position in Congress, who has been the leader of House Democrats for 20 years, announced earlier today that she's stepping down from her leadership position as soon as the 118th Congress takes office on January 3rd, 2023.
Pelosi is a legend in the U.S. Congress, and no accomplishment more perfectly illustrates her skill than the passage of the Patient Protection & Affordable Care Act in 2009 - 2010.
There's one night I will remember most when thinking about Nancy Pelosi - the night I watched her single handedly save health care for 20 million Americans. It was at the first Democratic caucus meeting after Scott Brown won the special Senate election in Massachusetts.
Many rank-and-file Democrats were in a panic, and they lined up at the microphone to tell Pelosi that it was time for us to give up on the Affordable Care Act. Or chop it up into little pieces - as some in the White House were suggesting.
Voters in Kansas rejected a proposed state constitutional amendment Tuesday that would have said there was no right to an abortion in the state, according to The Associated Press.
Kansas was the first state to vote on abortion rights since the U.S. Supreme Court handed down its ruling in Dobbs v. Jackson's Women's Health Organization.
President Joe Biden hailed Tuesday's vote and called on Congress to pass a law to restore nationwide abortion rights that were provided by Roe.
"This vote makes clear what we know: the majority of Americans agree that women should have access to abortion and should have the right to make their own health care decisions," Biden said in a statement.
The statewide abortion ban ballot proposal, in a fairly solidly red state, ended up failing by a massive 18 points, with 544,000 voting against it and only 378,00 in favor of it.
Measure 111: Enshrine the Right to Health Care in the State Constitution
Yes: 50.6%
No: 49.4%
>95% of votes in
Notwithstanding the slim possibility of it ultimately being defeated (Yes is up by around 20,000 votes as of this morning), it's important to understand that Measure 111 doesn't actually enact a specific healthcare coverage program. Here's an explainer of what it does do from More Perfect Union (published prior to it passing):
HSRI’s Open Enrollment period begins on November 1st and runs through January 31, 2023
PROVIDENCE, RI – Governor Dan McKee announced that tomorrow is the first day of Open Enrollment for Rhode Island’s health insurance marketplace, HealthSource RI (HSRI). From November 1, 2022 through January 31, 2023, individuals can enroll, change or renew their health coverage at HealthSourceRI.com/OE or 1-855-840-HSRI (1-855-840-4774).
To support this effort, trained and certified HSRI staff will hold the first of several virtual information sessions at 9:30 a.m. on November 3. Sign up information, as well as additional info sessions, can be found at HealthSourceRI.com/Events.
Wolf Administration Highlights Pennie® Open Enrollment Period for 2023 Coverage with Quality Plans, Affordable Monthly Premiums, and New Eligibility Opportunities for Financial Savings
Carlisle, PA – Representatives from the Pennsylvania Insurance Department (PID), Pennie, and Pennsylvania Association of Community Health Centers (PACHC) celebrated the beginning of the open enrollment period today at Sadler Health Center in Carlisle to remind Pennsylvanians that Pennie, the commonwealth’s official online health insurance marketplace, is now open for all Pennsylvanians to apply, compare plans, and enroll in high-quality health coverage. This annual Open Enrollment Period is an opportunity for Pennsylvanians to take advantage of substantial savings on 2023 coverage created by the American Rescue Plan and extended by the Inflation Reduction Act.
November 1, 2022 – Starting today, people who need health insurance can get coverage that delivers high-quality, comprehensive benefits – including new $0 co-pays for some chronic illnesses – while also getting help paying for their coverage through the Massachusetts Health Connector.
Open Enrollment runs through Jan. 23, 2023, with a deadline of Dec. 23 for people who want to start the New Year with coverage. The Health Connector is the only place where Massachusetts residents can access help paying for coverage, and all Health Connector plans meet state and federal standards, delivering the peace of mind that comes with having usable, affordable health insurance. Adult residents in Massachusetts are required to have health insurance coverage. People can find coverage at MAhealthconnector.org.
With health insurance, you’re protected from the unexpected.
BALTIMORE (Nov. 1, 2022) – Marylanders can now enroll in health plans for 2023 on MarylandHealthConnection.gov, the state’s health insurance marketplace.
Open enrollment runs from Nov. 1, 2022, through Jan. 15, 2023. Coverage starts Jan. 1, 2023, for plans selected before Dec. 31, and coverage starts on Feb. 1, 2023, for plans selected the first two weeks of January. This open enrollment period is for private plans only. Those who qualify for Medicaid may enroll any time of year.
“Many of the savings available in 2022 have been extended into 2023, resulting in free and low-cost plans.” said Michele Eberle, executive director of the Maryland Health Benefit Exchange. “Accidents happen. You never know when you might need emergency care or a visit to a doctor or specialist. With health insurance, you’re covered for when the unexpected happens.”
SACRAMENTO, Calif. — Covered California launched its new television advertising campaign on Monday, to promote enrollment and encourage the uninsured throughout the state to sign up for quality health insurance. The multi-language campaign builds on the successful theme of “This Way to Health Insurance,” which has helped Covered California enroll a record-high 1.7 million people.
“Covered California is reaching out to our state’s diverse population to make sure all Californians know about the increased and expanded financial help that is available to help bring the cost of quality coverage within reach,” said Jessica Altman, executive director of Covered California. “We want to make sure people know that Covered California is here to help them get and pay for quality, brand-name health insurance.”
My conclusion was that there's likely to only be one statewide race* where a Republican candidate loses by less than the COVID death margin: The Nevada Senate race where, as of this writing, incumbent Democrat Catherine Cortez Masto is trailing Republican challenger Adam Laxalt by less than 800 votes. I estimate that somewhere between 900 - 2,400 more Trump voters than Biden voters died of COVID-19 over the past two years, so if Laxalt ends up losing by less than 2,400 votes, I'd say it's pretty likely that yes, the partisan gap in COVID deaths did indeed play a small but critical role.
According to official CDC data, around 815,000 Americans died of COVID-19 between 10/31/20 - 09/10/22. Of those, I had estimated that perhaps 569,000 had actually voted for Biden or Trump. The total number has tragically risen by around 7,000 more since mid-September, which means the number of 2020 voters who've died is also likely around 4,900 higher.
Nationally, Joe Biden received 81,283,501 votes to Donald Trump's 74,223,975 votes. If COVID impacted both voting blocs at identical rates, you'd normally expect roughly 9.5% more Biden voters to have died of COVID over the past 2 years than Trump voters...or roughly 25,000 more Biden voters.
...over the past few years, the voters of some of those states have decided to take it upon themselves to force their legislators/governors to expand Medicaid anyway, via statewide ballot initiative campaigns:
Unfortunately, Mississippi is one of the states which provided zero useful rate filing data for my purposes (preliminary or final) prior to the 2023 Open Enrollment Period launching, so I had to wait until now to post anything about it.
The only data I have is from the federal Rate Review website, and even the filing forms there are heavily redacted, so all I can put together are unweighted averages for the 2023 calendar year.
With that in mind, unsubsidized individual market enrollees are looking at average increases of around 5.3%, while small group rates are set to go up about 1.6% overall.
They break out the filings not between Individual and small group markets or on- vs. off-exchange policies, but between rate increases over and under 10%. Normally that would be fine, but they also have multiple listings within each market for several carriers; HMO Louisiana, in fact, has 11 entries, each for a different product line, making it tedious and difficult to piece together the weighted average rate change and current enrollment for the carrier as a whole.
Not that any of that matters this year, as they don't appear to have posted any of the ACA-compliant individual market filings there anyway. I had to rely entirely on the federal Rate Review site, and the filings there still don't include enrollment data for most carriers, so the averages below are all unweighted only:
Alaska is also a sparsely populated state with only two carriers on their individual market and four on their small group market. Alaska's insurance department website is useless when it comes to getting rate filings or enrollment data; I had to use the federal Rate Review site to even get the requested rate changes.
Fortunately, Premera Blue Cross includes a summary which lists their enrollment numbers, and with Moda being the only other carrier on the market, I was able to estimate a weighted average (assuming Moda only has around 2,200 enrollees, which seems about right given Alaska's total on-exchange enrollment of roughly 23,000 people).
However, the final/approved rate filings for 2023 are out now that we're into the Open Enrollment Period, and while Premera saw a slight reduction in their rate hike, Moda's are jumping from a 4% increase to a whopping 12.1%. Wow.
I'm pretty sure Wisconsin has the most competitive ACA markets in the country, at least in terms of the sheer number of insurance carriers offering policies on both the individual (15) and small group (20) markets.
The bad news is that it was extremely difficult to acquire Wisconsin's 2023 rate filings prior to the actual Open Enrollment Period launching this morning.
Overall, individual market premiums for unsubsidized enrollees are going up around 7.7%, while small group market rates are increasing by an unweighted average of 8.9%.
It's worth noting that two carriers (Health Tradition and Network) appear to be dropping out of the small group market, while one of the individual market players, Children's Community Health Plan, is changing their name to...Chorus Community Health Plan for whatever reason.
Massachusetts, which is arguably the original birthplace of the ACA depending on your point of view (the general "3-legged stool" structure originated here, but the ACA itself also has a lot of other provisions which are quite different), has 11 different carriers participating in the individual market. MA (along with Vermont) has merged their Individual and Small Group risk pools for premium setting purposes, so I'm not bothering breaking out the small group market in this case.
Gov. Whitmer Encourages Michiganders to Take Advantage of Savings on New Health Plan Choices During Open Enrollment
November 01, 2022
(LANSING, MICH) Governor Gretchen Whitmer and Michigan Department of Insurance and Financial Services (DIFS) Director Anita Fox are reminding Michiganders that the annual Health Insurance Marketplace open enrollment period begins today and runs through January 15, 2023. With savings still in effect making health insurance more affordable for more Michiganders, new grants for free local help, and more plan options than last year, shopping for health insurance has never been easier.
The good news about New Hampshire's health insurance market is that they're the only state without its own ACA exchange which produces publicly-accessible monthly reports on individual on-exchange market enrollment. The bad news is that they don't seem to publish the actual rate filings in an easy-to-read format, which means I'm left with the federal rate review website. The problem with that is the rate filings are mostly heavily redacted, making it impossible to get the total enrollment data.
