Charles Gaba's blog

Less than one year ago, in February 2020, I wrote a lengthy post about a great idea that New Mexico was attempting to put through which, had it succeeded, would have generated up to $125 million per year to be used primarily for reducing individual market premiums:

New Mexico would raise a state health-insurance tax and dedicate the new revenue to programs intended to make health care more affordable under a proposal that passed the state House on Sunday.

Rep. Deborah Armstrong, D-Albuquerque, described the legislation as an unusual opportunity to generate more revenue for health care without increasing the total amount consumers now pay.

The increased state tax would partially replace a federal tax that’s being repealed, she said, meaning health insurance carriers would actually be charged less in taxes than they are now, even after the state increase.

The legislation, House Bill 278, would raise about $125 million in annual revenue when fully phased in — the bulk of it dedicated to a new fund for health care affordability, according to legislative analysts.

Way back on November 30th (a lifetime ago!), my contact at the Massachusetts Health Connector gave me an unofficial mid-period 2021 enrollment report:

Here's where we are at, currently:

  • January effectuations: 275,003
  • Feb. and March effectuations: 5
  • Plan Selections: 9,143
  • Total enrollments: 284,151

As a reminder, "effectuations" have paid the first month premium and are good to go. Plan selections still need payment to start.

As I noted at the time, MA is one of just two states (the other is Rhode Island) which handles premium payments internally, which means they can easily track not just how many people have enrolled but how many have actually made their payments.

Yesterday I requested and received an update six weeks later, and was surprised to see the total number drop slightly:

via DC Health Link:

Hispanic leaders to discuss the vulnerability of Hispanic communities to COVID-19 and state of enrollment opportunities at 6th Annual Hispanic Leadership Health Forum; Virtual enrollment and outreach events scheduled throughout the week

WHAT: 
Despite national studies showing the Hispanic community saw the biggest drops in uninsured rates thanks to the Affordable Care Act (ACA), the uninsured rate for the Hispanic community continues to be significantly higher than in other minority communities, according to a recent United States Census report.

In celebration of the National Hispanic Enrollment Week of Action, DC Health Link—in partnership with the Mayor’s Office of Latino Affairs (MOLA), Greater Washington Hispanic Chamber of Commerce (GWHCC), Mary’s Center and other community based organizations—will host its Annual Hispanic Enrollment Week of Action. DC Health Link is using this Enrollment Week of Action to accelerate outreach efforts to promote, educate and motivate Hispanics to enroll in quality, affordable health insurance. The Hispanic Enrollment Week of Action runs from January 12, 2021 through January 16, 2020.

via the Nevada Health Link:

COVID-19 treatment, diagnosis and vaccines included in all Nevada Health Link plans

  • Open Enrollment ends at 11:59 p.m. Jan. 15, 2021 – three more days remaining

(CARSON CITY, NV) – With only three days remaining in Open Enrollment for 2021 health coverage, Nevada Health Link, the online health insurance marketplace operated by the state agency, the Silver State Health Insurance Exchange (Exchange), reminds Nevadans that all plans include access to COVID-19 related diagnosis and treatment, including COVID-19 vaccines when they become available.

via the Washington Health Benefit Exchange:

Last Days before Washington Healthplanfinder Open Enrollment Deadline

With the Jan. 15 deadline looming, Washingtonians still seeking 2021 health coverage must act now to select a plan on Washington Healthplanfinder. Customers have less than three days to shop for coverage that begins Feb. 1.

Traffic on Washington Healthplanfinder continues to be brisk this week as customers rush ahead of Friday’s deadline. So far, over 218,000 Washingtonians have signed up for 2021 coverage, including more than 40,000 new customers.

“The surge of enrollees securing health and dental coverage has been steady and shows the impact that the pandemic has had on our state,” said Chief Executive Officer Pam MacEwan. “There is limited time left for those who still haven’t enrolled in coverage and I encourage them to review their options on Washington Healthplanfinder.”

Back on December 19th, my colleagues Colin Baillio and Andrew Sprung picked up on something I had posted in response to the semi-final 2021 Open Enrollment snapshot report:

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.

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).

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

Final Snapshot, November 1 - December 21, 2020

Approximately 8.3 million people selected or were automatically re-enrolled in plans using the HealthCare.gov platform during the 2021 Open Enrollment period.

These snapshots provide point-in-time estimates of weekly plan selections, call center activity and visits to HealthCare.gov or CuidadoDeSalud.gov. The final snapshot reports new plan selections, active plan renewals and automatic renewals. It does not report the number of consumers who paid premiums to effectuate their enrollment.

As a reminder, New Jersey and Pennsylvania transitioned to their own State-based Exchange platforms for 2021, thus they are not on the HealthCare.gov platform for 2021 coverage. Those two states accounted for 578,251 plan selections or 7% of all plan selections during the 2020 Open Enrollment Period. Plan selections for 2021 coverage in these two states will not appear in our figures until we announce the State-based Exchange plan selections.

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.

via KOLO 8:

New law clearly separates short term limited medical plans from Health Link

RENO, Nev. (KOLO) - Broker Alex Sampson is busy these days helping local residents connect with a health insurance program through Nevada Health Link.

But just seven days ago, a new law went into effect here in Nevada which may make the process less confusing for consumers looking for health care insurance coverage on their own.

The law impacts short term limited health medical plans. These are plans which provide very limited coverage for one year only to customers and could be confused with policies on Health Link.

“They are being advertised as extremely affordable plans,” says Janel Davis, Health Link Communications Officer. “But again when they go to use those plans and they go to the hospital for example, what they are finding out; what they need health wise is not covered,” says Davis.

Needless to say, it's been difficult to focus too much on healthcare issues the past few days.

In addition, it's not like the deadly invasion, occupation & attempted coup attempt of the U.S. Capitol by a violent mob incited by the President of the United States himself has a whole lot of healthcare policy side stories, unless you're talking about the entire incident also being a COVID-19 superspreader event, what sort of healthcare coverage the dozens of injured police officers have or whether eye injuries due to being maced are covered by healthcare policies.

However, this breaking announcement seems to fit the bill. via Rachana Pradhan of Kaiser Health News, on Twitter:

Whoa: the Blue Cross Blue Shield Association, whose companies provide health insurance to 100+ million Americans across the country, is suspending political contributions to members of Congress who objected to the Electoral College count. Statement below:

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 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.

With these updates in mind, here's the top 100 counties ranked by per capita COVID-19 cases as of Friday, January 8th, 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

via the Washington Health Benefit Exchange:

Record number of Washingtonians secured health insurance coverage through Washington Healthplanfinder in 2020

In a year defined by a health crisis, 2020 saw more than two million Washingtonians enrolled in Washington Apple Health (Medicaid) and Qualified Health Plans. This is a new record high number of individuals and families obtaining health coverage through Washington Healthplanfinder, the online portal administered by the Washington Health Benefit Exchange (Exchange). Over 1 in 4 Washingtonians are using Washington Healthplanfinder to find and enroll in health coverage. Open enrollment for 2021 coverage runs through Jan. 15 of this year with coverage starting Feb. 1.

Approximately two million residents received free or low-cost Apple Health coverage, and the remaining 215,000 enrolled in Qualified Health Plans. This past December saw an average of 1,500 individuals a day enrolled in Apple Health.

Access Health CT, Connecticut's state-based ACA exchange, has updated their enrollment summary and now reports 102,704 residents have selected policies for 2021, including 16,764 new enrollees.

Last year they had a total of 107,833 QHP selections during Open Enrollment, which they're 4.8% away from breaking.

Connecticut residents still have until January 15th to #GetCovered via AccessHealthCT.com.

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 broken 12.3% of the entire population having tested positive, or nearly 1 out of every 8 residents.

South Dakota is up to 11.5%, or more than 1 out of every 9 residents.

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

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