Charles Gaba's blog

Merry Christmas to those who celebrate! As a Jew, my Christmas Eve activity consists of...digging through the Covered California November Board of Directors monthly Executive Director's Report slideshow!

There's a bunch of useful wonky data stuff, but for purposes of this entry, it's slides 18 & 19 which are of particular interest. Most state-based ACA exchanges don't launch Open Enrollment until November 1st, but Covered California opens up re-enrollment for current members earlier. Usually they let current members renew for the upcoming year as early as October 15th, but this year they moved that up even sooner, to October 1st.

As a result, while they haven't put out any official press releases about it, as of November 16th, over 1.4 million of their ~1.5 million existing enrollees had already been re-enrolled for 2021. In addition, they had another 32,000 Californians sign up in the first two weeks of November.

via the New Jersey Dept. of Banking & Insurance:

NJ Department of Banking and Insurance Cautions Residents Shopping for Health Insurance Against Health Plans that Do Not Provide Comprehensive Coverage

  • Warning Follows Action Against Aliera, Trinity for Using Deceptive Practices and Misleading Consumers

TRENTON — New Jersey Department of Banking and Insurance Commissioner Marlene Caride today urged residents shopping for health insurance this open enrollment period to be aware of health plans with limited coverage that – unlike the health plans available at Get Covered New Jersey, the state’s official health insurance Marketplace – do not cover basic services and pre-existing conditions.

This Just In from MNsure, Minnesota's state-based ACA exchange:

MNsure sees 4% increase in signups during this year's open enrollment period

  • More than 155,000 Minnesotans found coverage through MNsure.org

ST. PAUL, Minn.—From November 1 to December 22, 2020, more than 155,000 Minnesotans found health insurance coverage during MNsure's eighth open enrollment period. A total of 122,269 Minnesotans signed up for private health plans through the exchange, which is 4,729 more than the previous open enrollment period.

It's worth noting that the way MNsure categorizes ACA exchange enrollees is slightly different than how CMS does...according to the official 2020 Open Enrollment Period Report Public Use File, Minnesota only actually enrolled 110,042 people during last year's OEP. I'm not sure what happened to the 12,227 QHP selection difference, but assuming this year's 122.3K figure holds by CMS, it means they're actually up 11.1% year over year, not just 4.0%.

This is interesting...I just received the following email from the Michigan Dept. of Insurance & Financial Services

Michigan Joins Group of State Insurance Commissioners to Provide ACA Policy Recommendations to President-elect Biden

Anita Fox, Director of the Michigan Department of Insurance and Financial Services (DIFS), has joined a group of state insurance commissioners in a pledge to work with President-elect Joe Biden by providing health policy recommendations to the incoming administration.

The commissioners share President-elect Biden’s vision that no American should have to go without health care coverage. They believe comprehensive and progressive health care is essential to addressing urgent public health priorities, such as the COVID-19 and opioid crises, addressing racial disparities in the health care system, and ensuring enforcement of mental health parity.

Last week I wrote about how my friend Laura Packard, along with up to 44,000 others, is in serious danger of losing access to critically important cancer treatment and other services due to a falling out between one of the largest health insurance carriers and one of the largest medical centers in Colorado:

Denver-area Anthem customers on Colorado exchange forced to switch doctors

DENVER (KDVR) — Laura Packard was diagnosed with stage 4 Hodgkins-Lymphoma cancer in 2017. The 44-year-old moved from Nevada to Colorado in 2019 for one reason: the state’s heath insurance exchange that provides affordable options to individuals who otherwise can’t get coverage.

Doctors at UCHealth have continued to treat Packard to make sure she stays cancer-free.

Earlier this evening, U.S. Senator Bernie Sanders of Vermont tweeted this:

Good politics: Over the past decade, every Medicare for All co-sponsor up for re-election beat their Republican opponent – every single one.

Good policy: Medicare for All would save 68,000 lives and cost $650 billion LESS than our current dysfunctional healthcare system a year.

— Bernie Sanders (@BernieSanders) December 22, 2020

I'm not gonna dig back through the past 5 election cycles to verify whether this claim is accurate or not, but I did at least check into it for the most recent election last month.

A reminder from MNsure, Minnesota's ACA exchange:

MNsure's Open Enrollment Period Ends Tuesday, December 22 at Midnight

December 21, 2020

ST. PAUL, Minn.—Minnesotans looking for private health insurance beginning January 1, 2021, have until 11:59 p.m. on Tuesday, December 22 to enroll in coverage through MNsure.

"Don't miss your chance to get health insurance coverage in the new year," said MNsure CEO Nate Clark. "Come to MNsure.org to compare your options and see if you qualify for financial benefits to lower the cost of your insurance—most Minnesotans do! Get enrolled today and have the peace of mind that comes with knowing you’ve got comprehensive health coverage."

MNsure's Contact Center is open from 8 a.m. to 9 p.m. on Monday, December 21 and 8 a.m. to midnight on Tuesday, December 22.

Most people qualify for financial help. Minnesotans can see their estimated eligibility for financial help by using MNsure's plan comparison tool.

I'm over a month late on this, but the DC Health Benefit Exchange Authority issued a mid-OEP enrollment report at their November board meeting (unfortunately they don't appear to have done so at their December meeting), so here it is as of 11/16.

Ther's not a whole lot of interest here, but it's worth noting that DC's effectuated enrollment in November was 7.6% higher than a year ago. This is again likely due to the extended "open" COVID-19 Special Enrollment Period in 2020:

Well, for good or for bad, it's finally here: The stripped-down-but-bipartisan COVID19 relief bill.

You can read the whole thing here...if you have a LOT of spare time on your hands. It's 5,600 pages long, 1.1 million words. For context, the entire Lord of the Rings trilogy is only half that length (576,000 words).

There's 1,000 explainers being written today about the most obvious stuff (the $600 direct relief checks, the extended & enhanced unemployment funding, etc etc), most of which falls far short of what's actually needed. Instead, I'm focusing on the ACA-related provisions. I already wrote about the surprise billing prohibition this morning, of course, but a quick initial scan of the text (which isn't easy...again, 5,600 pages...) reveals several other items directly related to the Affordable Care Act, so let's take a look! (Note: I'm sure I'm missing a few):

Page 4,206:

 

Over six months after House Democrats passed a robust COVID-19 relief bill (only to see it continuously blocked by Republican Senate Majority Leader Mitch McConnell), it looks like Congress is finally set to compromise on a vastly stripped-down bipartisan bill which would provide at least a small amount of relief for hundreds of millions of American families and businesses.

While the bill is underwhelming (to put it mildly) overall, it does include several important provisions, one of which is a long-sought solution to a massive healthcare problem which existed long before COVID came knocking at our door nearly a year ago: Surprise Billing.

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

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:

  • I've now completed updating the partisan lean for every county except Alaska (I'm having trouble getting that broken out by "County-Equivalent Region") to the 2020 Biden/Trump results. Alaska still uses the Clinton/Trump 2016 results, although I can't imagine more than one or two regions changed status there this year.
  • 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 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.
  • I've also added all U.S. territories, including a county-equivalent breakout for Puerto Rico, as well as American Samoa, Guam and the U.S. Virgin Islands. None of these vote in the general Presidential election, of course, but I'm still tracking their COVID-19 case & death rates. None show up in the top 100 of either ranking, however. Note that Puerto Rico only includes the case breakout, not deaths, which are unavailable for some reason.
  • Finally, I corrected a significant error on my part in the Blue/Red County Ratio graph (see below)

With these updates in mind, here's the top 100 counties ranked by per capita COVID-19 cases as of Friday, December 18th (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

In my Twitter thread yesterday breaking out the semi-final HC.gov weekly snapshot enrollment report, I noted:

STATE LEVEL:
--25 out of 36 states outperformed last year
--Best % increase y/y: TEXAS (+14.9%)
--Worst $ decrease y/y: KENTUCKY (-6.7%)

I have no idea if there's anything special in either state which caused either to do as well/poorly as they did relative to last year.

My colleagues Colin Baillio and Andrew Sprung took note of this, and Sprung decided to look into it further. He broke out the states between Medicaid expansion and non-expansion states, and voila:

From the state totals one obvious pattern leaps out: enrollment is up 9.7% in states that have not enacted the ACA Medicaid expansion -- and down 0.5% in states that have expanded the expansion (including Nebraska, which opened the Medicaid expansion doors in October of this year).

Access Health CT, Connecticut's state-based ACA exchange, has updated their enrollment summary and now reports 102,049 residents have selected policies for 2021, including 15,310 new enrollees.

Last year they had a total of 107,833 QHP selections during Open Enrollment, which they're just 5.4% away from breaking.

In addition, as noted a few days ago, they're also extending their deadline by a full month (whcih they also did last year):

via Access Health CT:

Access Health CT Extends 2021 Annual Open Enrollment Period As A Result Of Current Health Crisis

CT residents can shop and enroll in health insurance coverage until January 15, 2021

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