Charles Gaba's blog

Earlier this evening, the House Ways & Means Committee formally published the markup of nine legislative provisions which, if they all survive the process, will make up roughly half of President Biden's proposed $1.9 trillion COVID-19 relief package, aka the American Rescue Plan:

The Ways and Means’ proposals comprise half of the $1.9 trillion Democratic COVID-19 relief package

SPRINGFIELD, MA – Today, House Ways and Means Committee Chairman Richard E. Neal (D-MA) announced the Committee will consider nine legislative proposals under the budget reconciliation instructions this week as the next step in delivering COVID-19 relief to the American people. Beginning on Wednesday, February 10, 2021 at 10:00 a.m. through Friday, February 12, 2021, the Committee will markup proposals spanning from extending unemployment insurance to expanding the child tax credit to delivering another round of direct assistance to struggling Americans.

Just over a month ago, I noticed that the Washington Healthplanfinder was touting the fairly impressive launch of their new "Cascade Care" healthcare plans overall (40% of new enrollees were choosing them!)...but that completely missing from all the praise was any breakout of how many were selecting the Public Option version of "Cascade Care"...likely for a very good reason:

Let's step back a moment: There's actually up to three types of policies being offered depending on the carrier:

  • Qualified Health Plans (QHPs)...these are the normal policies which comply with ACA regulations offered by most carriers.
  • Cascade (Standard)...these are QHPs which also follow another state law passed last year (see below), and
  • Cascade (Select)...these are Standardized QHPs which are also public option plans.

Here's the distinction between Cascade "standard" and Cascade "select":

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 188 swing districts (out of over 3,100 total), with around 33.8 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 5th, 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 1 out of every 9 residents.

Utah, Tennessee, Arizona, Iowa, Oklahoma and Arkansas 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 New Hampshire, Washington, Oregon, Maine, Hawaii & Vermont (along with 4 U.S. territories) have now surpassed 1 out of every 20 residents having tested positive.

Last week the Washington Health Benefit Exchange released their official 2021 Open Enrollment Period report.

The "final" OEP numbers are gonna be a little fuzzy in some state-based exchanges this year, of course. Several states had OEP deadlines which extended past the federal one as usual, including some which didn't end until January 31st. Due to the ongoing COVID-19 pandemic, however, several of those states went gone ahead and bumped their deadlines out further yet, through as late as March for Maryland and New York.

Then last week, of course, the Biden Administration announced that HealthCare.Gov is re-opening enrollment for a full three months starting on February 15th, and a bunch of state exchanges scrambled to announce their own additional re-openings or extensions...some of which already overlapped with those 1/31 deadlines.

The other day I posted a detailed look at just how much various households could save in premiums if H.R. 369, Rep. Lauren Underwood's Health Care Affordability Act of 2021, were to be passed and signed into law by President Biden. I used 8 different household examples, and based the savings on the national average 2021 benchmark premium for a single 40-year old, according to the Kaiser Family Foundation.

The households I used include:

Huh...this is interesting. I noted a few weeks back that the Massachusetts Health Connector reported 11% fewer people had enrolled in Qualifying Health Plans (QHPs) for 2021 as of mid-January than they had during the 2020 Open Enrollment Period. At the time, they were running about 6% behind year over year, and attributed the enrollment drop (the first in the MA Health Connector's history since the first Open Enrollment Period back in 2013-2014) primarily to Medicaid enrollment:

Lower membership is primarily the result of decreased new enrollments rather than termination of existing members, likely due to Medicaid protections associated with the federal public health emergency.

The new Pennsylvania ACA exchange, Pennie, just issued their final official 2021 Open Enrollment report and (as expected) is also joining most other states in re-opening for a COVID-19 Enrollment Period:

Press Release – Pennie Exceeds Expectations & Extends Enrollment for COVID-19

  • As a state-based marketplace, Pennie increases new enrollment by 9.7% and raises total enrollment to nearly 338,000. Now, Pennie is offering more time to enroll in plans for those affected by COVID-19.
  • Pennsylvanians who have recently lost health coverage or have been affected by COVID-19 can visit pennie.com and enroll in a plan from February 15 through May 15.

This just in via the MA Health Connector...

February 3, 2021 – The Massachusetts Health Connector announced today a further extension of its Open Enrollment through May 23, providing residents impacted by COVID-19 the opportunity to get access to affordable, comprehensive health insurance.

The Health Connector previously announced an extension of Open Enrollment through March 23, two additional months beyond the original Jan. 23 deadline. Open Enrollment started Nov. 1, and the new deadline of May 23 aligns the Massachusetts health insurance exchange with the new open enrollment period for the federal exchange platform, healthcare.gov, which reopens Feb. 15 and remains open through May 15, and will be accompanied by a national marketing and awareness campaign.

This just in from the DC Health Link...

DC Residents Without Health Insurance Can Get Covered Now Through DC Health Link

Annual Open Enrollment is over, but DC Health Link’s COVID-19 Special Enrollment Period continues through the duration of DC’s public health emergency

(Washington, DC­­) – Uninsured District of Columbia residents have more time to enroll in health coverage for 2021. From now through the end of the COVID-19 pandemic, residents can enroll using DC Health Link’s Special Enrollment Period (SEP) for COVID-19. All DC Health Link plans cover diagnosis, treatment, testing, and vaccination for COVID-19 for free.

Over the past couple of years, one of the things I've become known for is my obsessive fixation on visually displaying how much various households would save on healthcare premiums if various ACA subsidy-boosting bills were passed compared with the current ACA subsidy structure.

For the most part, I've focued on the Advance Premium Tax Credit (APTC) subsidy table first proposed way back in August 2015 by Linda J. Blumberg and John Holahan of the Urban Institute. The previous Big Supreme Court ACA Lawsuit Ruling had just come out (King vs. Burwell), and with the ACA having just been spared yet again (temporarily), Blumberg & Holahan proposed two major enhancements to the law:

Add Health Source RI to the list:

HealthSource RI Joins President Biden and Announces New Health Coverage Enrollment Period

EAST PROVIDENCE, Rhode Island (February 1, 2021) — Following President Biden’s announcement on Thursday January 28, HealthSource RI has established a new enrollment period to give Rhode Islanders additional time to sign up for health coverage. Uninsured Rhode Islanders can enroll for coverage effective as early as March 1. HealthSource RI’s enrollment period will continue through May 15, 2021.

This enrollment period is open to all eligible uninsured Rhode Islanders, with no requirement to have a qualifying life event to enroll in health coverage.  Coverage starts the first of the month following a complete enrollment.

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 188 swing districts (out of over 3,100 total), with around 33.8 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 Saturday, January 30th, 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.

North Dakota has reached 12.8% of the entire population having tested positive, or over 1 out of every 8 residents.

South Dakota is up to 12.2%, or more than 1 out of every 9 residents.

Rhode Island, Utah, Tennessee, Arizona and Iowa are up to 1 out of every 10 residents having tested positive.

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

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

via the Nevada Health Link...

Today, the Biden‐Harris Administration announced a Special Enrollment Period, allowing Americans to enroll and purchase on‐Exchange health insurance plans from their respective on‐Exchange marketplaces. On behalf of the Silver State Health Insurance Exchange and Nevadans statewide, we are pleased to see positive change taking place at the federal level and to witness the fast‐moving actions to protect the Affordable Care Act (ACA), upon which so many Americans rely for quality, affordable and comprehensive health insurance coverage.

This news comes on the heels of our announcement that nearly 82,000 Nevadans enrolled on Nevada Health Link for coverage in 2021. That’s nearly a six percent increase from last year’s enrollment total.

Today’s news from the White House speaks volumes about how the new Administration will continue to support the ACA and help to bolster the health insurance marketplace, protecting hundreds of millions of Americans.

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