Charles Gaba's blog

via the Washington Health Benefit Exchange:

Over 200,000 have signed up for health coverage; Get covered by December 15 on Washington Healthplanfinder

  • Beat the rush by signing up today on Get Covered Day #GetCovered2021

OLYMPIA, Wash. -- As sign ups continue to increase, Washington Healthplanfinder reminds individuals today, Get Covered Day, to visit WA HealthPlan Finder to secure their health and dental coverage by Dec. 15 to ensure a start date of Jan. 1, 2021.

As of Dec. 10, over 200,000 Washingtonians have signed up for 2021 coverage, 5% more than last year at this time, and one person every 17 seconds. Among the 20,000 new customers, over 40% have selected a new Cascade Care plan. These new plans offer deductibles that are on average $1,000 less than other plans, and cover more services prior to meeting a deductible, including primary care visits, mental health services, and generic drugs.

via Your Health Idaho:

Less Than One Week to Enroll in 2021 Health Insurance

  • Your Health Idaho extends customer support hours ahead of Dec. 15 deadline

BOISE, Idaho – Idahoans have until 11:59 p.m. (MT) on Tuesday, Dec. 15, to enroll in 2021 health insurance coverage through Your Health Idaho, the state insurance exchange. After open enrollment ends, Idahoans will not be able to enroll in coverage unless they qualify for a Special Enrollment Period.

“As expected after the Thanksgiving holiday, we have seen an increased interest from Idahoans looking to enroll in 2021 health insurance coverage,” said Your Health Idaho Executive Director, Pat Kelly. “To ensure consumers are getting the help they need, Your Health Idaho has expanded business hours through December and implemented new contact options.”

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.

Hot off the presses, via the Centers for Medicare & Medicaid:

Week Five, November 29 - December 5, 2020

In Week Five of the 2021 Open Enrollment period, 915,118 people selected plans using the platform. As in past years, enrollment weeks are measured Sunday through Saturday.

Every week during Open Enrollment, the Centers for Medicare & Medicaid Services (CMS) will release enrollment snapshots for the platform, which is used by the Federally-facilitated Exchange and some State-based Exchanges. These snapshots provide point-in-time estimates of weekly plan selections, call center activity, and visits to or

The final number of plan selections associated with enrollment activity during a reporting period may change due to plan modifications or cancellations. In addition, the weekly snapshot only reports new plan selections and active plan renewals and does not report the number of consumers who have paid premiums to effectuate their enrollment.

  • “Get Covered America Day” — Dec. 10 — is a call to wear a mask to prevent the spread of COVID-19 and a public statement that you want your family and friends to get health insurance.
  • With COVID-19 cases surging nationally, the day is a call to action to encourage people to post a picture of themselves wearing a mask on social media, include a personal message about the importance of being COVID-safe and how friends, family and neighbors can get financial help for insurance now, sharing the website and using the hashtag #GetCovered2021.
  • With an estimated 16 million uninsured Americans eligible for financial help — through their Affordable Care Act marketplace, or free coverage through Medicaid — Get Covered 2021 encourages people to check their health care options and get insured.

    via Pennie, PA's new ACA exchange:

    December 15 is the Deadline for Individuals to Enroll in Health Insurance Coverage for January 

    • Pennie urges all Pennsylvanians seeking 2021 coverage to enroll this Open Enrollment 

    Harrisburg, PA – December 7, 2020 –  Pennie, the state’s new health insurance marketplace is approaching its first enrollment deadline. December 15th is the last day for individuals and families to purchase health coverage starting January 2021. Current and potential customers are encouraged to select a plan by December 15 to ensure continuous coverage.

    Pennie allows customers to compare and shop for medical and dental insurance from participating insurers, who are required to offer qualified, comprehensive plans. Pennie is also the only source for financial assistance to help lower the cost of coverage and care and nearly 9 out of 10 of customers qualify for financial assistance

    via Connect for Health Colorado:

    Marketplace Enrollments Trending Higher During Pandemic; Deadline for Jan. 1 Coverage Approaches

    DENVER – Through Dec. 6, more than 148,000 Coloradans have signed up for a health insurance plan through Connect for Health Colorado. Initial enrollment totals show that more Coloradans are getting covered this Open Enrollment Period as the pandemic grows in Colorado. 

    “I’m encouraged that so many people have signed up for a medical plan that will give them the coverage they need. I hope this also gives them some peace of mind going into the new year,” said Chief Executive Officer Kevin Patterson. “I urge Coloradans who haven’t enrolled yet to take advantage of the free enrollment assistance we offer. We’re here to help as many Coloradans as possible get covered for January 1st.”

    Of all the elected officials who have been aping Donald Trump's horrific COVID-19 pandemic denialism, perhaps none have been worse (at least in terms of actual policy impact) than Republican South Dakota Governor Kristi Noem.

    Not only has Gov. Noem refused to take any significant action to slow the spread of COVID-19, she's openly mocked those who do and is even starring in TV ads encouraging tourism of South Dakota based on her refusal to impose any reasonable measures using federal COVID-19 relief funding...even as South Dakota has become the second worst COVID hot spot in the nation (first place? SD's neighbor to the north...North Dakota).

    In response to widespread criticism, Gov. Noem today penned an Op-Ed for the Wall St. Journal in which she argues that everything is actually peachy-kean in the Mount Rushmore State:

    The other day this depressing tweet was posted by the Dean of Brown University School of Public Health:

    There were 225,000 new cases identified yesterday
    Sat through Monday, cases will dip (usually do)
    But we are now seeing Thanksgiving effect
    Based on yesterday's cases alone
    Expect 5K-6K hospitalizations 12/11 (if hospitals can accommodate)
    and 4,000 deaths on 12/26


    — Ashish K. Jha, MD, MPH (@ashishkjha) December 5, 2020

    This was a very specific projection (especially the 4,000 deaths on 12/26) so I decided to do the math. Deaths have been lagging positive tests by around three weeks, give or take, so in theory you should just have to go back to see how many people tested positive 21 days earlier to get an idea of how many people will  die on a given well as letting you project the death toll up to three weeks ahead, as Dr. Jha did above.

    I suppose this was inevitable, but it's grating nonetheless, and especially so given that we're in the middle of a pandemic which has caused tens of millions of Americans to lose their jobs:

    The Supreme Court agreed Friday to consider a Trump administration plan to let states impose work requirements on some who receive health-care benefits under the Medicaid program for the poor.

    Arkansas and New Hampshire want to continue programs halted by lower courts, and more than a dozen other states say they want to impose similar requirements.

    But despite the Supreme Court’s willingness to take up the issue, the incoming Biden administration might have other ideas, and opponents called on it to reverse endorsement of the work requirements.

    • Physicians and health centers across the state announce they are reaching out personally to all their patients to encourage them to stay safe from COVID and get insurance coverage if they are eligible — many will receive Covered California’s masks to get the message out that now is the time to get covered and stay covered.
    • California’s leading provider organizations — including the California Hospital Association, California Medical Association, California Academy of Family Physicians, the California Primary Care Association and America’s Medical Groups — are making sure the trusted voice of physicians and other health care heroes are speaking to millions of Californians with the message of remaining vigilant until the vaccine arrives.
    • According to a survey conducted by Covered California, the pandemic continues to touch most Californians, finding that 52 percent of Californians say the pandemic has affected their lives significantly, more than 40 percent personally know someone who has tested positive for the virus, and more than one in four people knows someone who has died from COVID-19.

      No snarky headline here. After weeks of speculation, President-Elect Joe Biden made it official this morning:

      President-elect Joseph R. Biden Jr. has selected Xavier Becerra, the Democratic attorney general of California, as his nominee for secretary of health and human services, tapping a former congressman who would be the first Latino to run the department as it battles the surging coronavirus pandemic.

      Mr. Becerra became Mr. Biden’s clear choice only over the past few days, according to people familiar with the transition’s deliberations, and was a surprise. Mr. Becerra has carved out a profile on the issues of criminal justice and immigration, and he was long thought to be a candidate for attorney general.

      But as attorney general in California, he has been at the forefront of legal efforts on health care, leading 20 states and the District of Columbia in a campaign to protect the Affordable Care Act from being dismantled by his Republican counterparts. He has also been vocal in the Democratic Party about fighting for women’s health.

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

      I was doing this earlier in the summer but stopped updating it in August; I've started over with a fresh spreadsheet and have expanded it to include every U.S. territory, including not just DC & Puerto Rico but also American Samoa, Guam, the U.S. Virgin Islands and even the Northern Mariana Islands.

      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. 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, which are skyrocketing.

      North Dakota recently became the first state to cross the 10% infection threshold, with South Dakota not far behind. Iowa, Wisconsin, Nebraska and Utah could all potentially hit the 10% milestone by New Year's Eve as well.

      The data below comes from the GitHub data repositories of Johns Hopkins University, except for Utah, which come 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 made some important changes starting last week:

      • First: I had been using the 2016 Trump/Clinton election results for partisan lean for each county. Now that the dust has (mostly) settled on the 2020 election, I've updated this to the Biden/Trump results for 2020. There's a few states where I don't have county-level data for 2020 yet (AK, CT, NY). I hope to have the final three states updated by next weekend, but am using 2016 data until then.
      • Second: I've also added columns listing the actual Biden/Trump vote percentage for each county to give a feel for how partisan it is. Again, I'm defining "Swing District" as any county where the difference is less than 6.0%. There's 185 swing districts (out of over 3,100 total), with around 35 million Americans out of 331 million total, or roughly 10.6% of the U.S. population.

      With these updates in mind, here's the top 100 counties ranked by per capita COVID-19 cases as of Saturday, December 5th (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

      Access Health CT, Connecticut's ACA exchange, is posting updates to their Open Enrollment Period (OEP) numbers every Friday. Last week they reported 100,345 Qualified Health Plan (QHP) selections during the first 33 days of the 2021 OEP, which sounds more impressive than it is, since 94,713 of those were current enrollees having their auto-renewals front-loaded; only 5,632 of them were actually new enrollees. Nothing wrong with that, of course.

      This week, they report that they have just 91,965 total QHP selections, of which 7,474 are new.

      On the surface this makes no sense...this is around 8,400 fewer than last week!