Charles Gaba's blog

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 Access Health CT:

Access Health CT To Host Two Educational “Healthy Chats” During Special Enrollment Period

  • Free Virtual Sessions to Help Uninsured Connecticut Residents Get Covered    

HARTFORD, Conn. (March 4, 2021) — Access Health CT (AHCT) announced today it will host two educational sessions called “Healthy Chats” on Tuesday, March 9 at 6:00 p.m. and Wednesday, March 10 at 6:00 p.m. (Spanish only) to help Connecticut residents learn about plan options, financial help, low-cost and free coverage and tips to stay covered during the Special Enrollment Period that runs until March 15, 2021*. The Special Enrollment Period is for consumers who are not currently enrolled in coverage through AHCT.

About these Healthy Chats

The Healthy Chat events are free and will be held virtually via Zoom (in English & Spanish). To join, attendees can access the event here, or here.

But actually, he thought as he re-adjusted the Ministry of Plenty’s figures, it was not even forgery. It was merely the substitution of one piece of nonsense for another. Most of the material that you were dealing with had no connexion with anything in the real world, not even the kind of connexion that is contained in a direct lie. Statistics were just as much a fantasy in their original version as in their rectified version. A great deal of the time you were expected to make them up out of your head.

Back in late January, when it became clear that the Biden Administration was planning on announcing some sort of "no excuse needed" COVID Special Enrollment Period for the federal ACA exchange, I did a little back-of-the-envelope math to try and get an idea of how many additional people might enroll via HealthCare.Gov than you'd normally see via "standard" Special Enrollment Periods.

At the time, I concluded that for a 60-day SEP of this nature (that is, one completely open to all comers regardless of whether they had a Qualifying Life Experience (QLE)or not), you might be looking at perhaps an extra 400,000 people. selecting plans during that time period. This would be on top of the 4,200/day who enrolled thru HC.gov between the end of Open Enrollment and the end of May via SEPs over the past couple of years, which would be roughly 254,000 for a 60-day period.

Answer: When you start seeing consumer fraud stories in the vein of Rick Scott's 1990's Medicare fraud scam.

Via Kelsey Waddill of Health Payer Intelligence:

March 02, 2021 - In a nationwide case, two individuals have been found guilty of an Affordable Care Act enrollment fraud scheme that used individuals in need of substance abuse care and falsely enrolled them in Affordable Care Act plans, the Department of Justice (DOJ) announced.

The defendants, Jeffrey White and Nicholas White who are father and son respectively, sought to enroll individuals in Affordable Care Act plans in states other than their own, specifically states that had high reimbursement rates for substance abuse treatment.

The two men went so far as to create fake residential addresses and cell phone numbers with accurate area codes that would direct the call to the Whites’ phones.

I'm a couple of weeks behind on this (the full #AmRescuePlan, #HR1319, already passed the House late last Friday night), but Medicaid expansion is one of the core issues I cover here, so it didn't feel right not to give this a write-up.

Before the Affordable Care Act was passed, only certain populations were eligible for Medicaid. Low-income children, pregnant women, parents of minor children and those with certain disabilities and so forth were eligible up to a certain household income threshold ranging from as a ceiling of as little as 13% of the Federal Poverty Line (parents in Alabama) to as much as 375% FPL (pregnant women and newborn infants in, interestingly, Iowa).

A reminder from Your Health Idaho (via email):

Uninsured Special Enrollment Period in Idaho Begins March 1

  • Idahoans who enroll will have coverage beginning April 1, 2021 

BOISE, Idaho – Your Health Idaho, the state insurance exchange, reopens today for Idahoans still seeking 2021 health insurance. Between March 1, and March 31, 2021, uninsured Idahoans can enroll in comprehensive health insurance coverage through the Uninsured Special Enrollment Period.  

This Special Enrollment Period is available for any uninsured Idahoan who missed the open enrollment window and is still seeking health insurance for 2021. Idahoans who enroll by the March 31, deadline will have coverage beginning April 1, 2021. 

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 dwarfed by North & South Dakota, although things are pretty horrible nearly 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, Iowa, Tennessee, Arizona, Oklahoma, Arkansas, Nebraska, Kansas, Alabama and South Carolina are up to 1 out of every 10 residents.

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

EVERY state except Washington, Oregon, Maine, Vermont & Hawaii, along with the territories of Guam, U.S. Virgin Islands, the Northern Mariana Islands and American Samoa have now surpassed 1 out of every 20 residents having tested positive.

As I did when Access Health CT released their 2021 OEP report, there's so much data here I'm not gonna bother doing any analysis in this entry; I'll just post the most relevant slides for now.

Note: Pennie refers to it as their 2020 annual report, but the enrollment data refers to the 2021 Open Enrollment Period.

OK, Covered California hasn't actually released an official press release or Open Enrollment Report, but I have acquired a single slide which was delivered at a university presentation by Covered CA head Peter Lee the other day. It doesn't provide tons of detail but give the most important toplines (the way the graph breaks out the numbers is a little confusing but I figured it out:

  • Total QHP selections from 11/01/20 - 1/31/21: 1.63 million, a record high for the state

This is a 5.9% increase year over year from the 2020 OEP's 1.54 million (it says 1.57 million on the graph but the official CMS tally is 1,538,819).

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 Thursday, February 25th, 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

Aside from Health Sherpa's announcement the other day that they enrolled over 3x as many people in ACA exchange plans in the first week of the COVID Special Enrollment Period than they normally would via traditional SEPs during the same time period, there's been no hard COVID SEP data released...until now. Via the Washington HealthPlan Finder:

Special Enrollment Period for Health Coverage Now Available

  • Currently uninsured or those seeking new coverage can enroll today on Washington HealthplanfinderOLYMPIA, Wash.

Washington Healthplanfinder is now offering a special enrollment period for Washingtonians who are currently uninsured or seeking new coverage. This special enrollment period, in response to the current public health emergency, opened Feb. 15 and runs for 90 days, ending May 15, 2021.

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.

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