Charles Gaba's blog

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 Four, November 15 - November 28, 2020

In Week Four of the 2021 Open Enrollment period, 523,020 people selected plans using the HealthCare.gov 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 HealthCare.gov 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 HealthCare.gov or CuidadoDeSalud.gov.

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.

Nothing else for me to add.

These are iPad stations being prepared for virtual ICU end of life visits by a palliative care doc I know. Jesus. 

— i cant drive, n95 (@roto_tudor) December 3, 2020

via Your Health Idaho:

It is no secret that 2020 has been a challenging year for Idahoans. In addition to the health implications and long-term consequences of COVID-19, living in a global pandemic has changed the way Idahoans work, learn, and interact with friends and family.

Over the past year, COVID-19 has also highlighted the undeniable need for comprehensive health insurance and access to quality healthcare. However, in a year with so much uncertainty and change, it may seem like health insurance is unaffordable or something that we can go without. At Your Health Idaho we understand that budgets are tight, we also know that the peace of mind that comes with having coverage in the event of an emergency is priceless.

As 2020 draws to a close, so does the annual Open Enrollment period for health insurance. Right now, at YourHealthIdaho.org you can shop and compare hundreds of health insurance plans to find the right coverage for you and your family.

Reminder from MNsure, Minnesota's ACA exchange:

Compare plans through MNsure and see if you can save

  • More plan options available this year than ever before

ST. PAUL, Minn.—MNsure is reminding all Minnesotans, regardless of insurance status, to compare plans before the December 22 open enrollment deadline. Individuals who currently have health insurance elsewhere, are uninsured, or are already enrolled through MNsure are encouraged to see if they can save money. With new plan options available in every county in Minnesota, MNsure recommends using the plan comparison tool to view plans side by side and explore details about premiums, deductibles, out-of-pocket costs and more. Minnesotans who sign up by the deadline will have coverage beginning on January 1, 2021.

via the Nevada Health Link:

Nevada Health Link reminds Nevadans there are 45 days remaining to secure health insurance for 2021 coverage

Nevadans have until Dec. 31 to enroll in a Qualified Health Plan effective Jan. 1, 2021

Nevada Health Link, the online health insurance marketplace operated by the Silver State Health Insurance Exchange (Exchange), reminds Nevadans that Open Enrollment for a comprehensive, Affordable Care Act (ACA) compliant health plan for 2021 ends on Jan. 15, 2021. All plans offered through the Exchange cover the ten essential health benefits including pre-existing conditions and all COVID-19-related diagnosis and treatment. Consumers should know they must enroll in a plan by Dec. 31, 2020 to have health coverage effective Jan. 1, 2021. Anyone who enrolls between Jan. 1 and Jan. 15 will have coverage effective Feb. 1, 2021.

Health Insurance Town Halls Offered to Michigan Consumers with Questions about Open Enrollment 

Thousands of Michiganders have lost health coverage during the COVID-19 pandemic, and the Michigan Department of Insurance and Financial Services (DIFS) is offering virtual town hall events to help answer questions about open enrollment on the Health Insurance Marketplace, which runs until Dec. 15.  

These live online town hall meetings are part of a series of events that will help consumers learn and ask questions about signing up for a health plan on the Health Insurance Marketplace. To attend a virtual town hall event, click the event link at its start time. Instructions for attendees are available and explain how to join an event and ask questions. 

Event Information: 

The Massachusetts Health Connector (MA's ACA exchange) doesn't generally post official enrollment data reports via press releases, but I have a contact there who sends me their latest numbers from time to time during Open Enrollment:

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.

Massachusetts is a bit unique among the ACA exchanges--they, along with Rhode Island, are the only ones which handle premium payments as well as policy enrollments. This means that they don't just track how many people select policies, they also know how many of those who enroll have actually paid their monthly premiums.

Access Health CT, Connecticut's ACA exchange, is posting updates to their Open Enrollment Period (OEP) numbers every Friday. Last week they reported 100,094 Qualified Health Plan (QHP) selections during the first 20 days of the 2021 OEP, which sounds more impressive than it is, since 95,857 of those were current enrollees having their auto-renewals front-loaded; only 4,237 of them were actually new enrollees. Nothing wrong with that, of course.

This week, they report that they have 100,345 total QHP selections, of which 5,632 are new. On the surface this sounds off...shouldn't it be 101,489 total? I'm pretty sure the reason for the discrepancy is that not every current enrollee actually renews/re-enrolls for the following year. The exchange plugs them in as renewing, but they can still go in and actively cancel their renewal, which reduces the total a bit. In this case, it sounds like 1,144 current enrollees have done so over the past week. This gives a net increase of 251 over the past week, or 36 per day.

"Picture 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've made some important changes starting this week:

  • First: Until now, I've 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, MA, NH, NY, RI & VT). In most of these states it's only broken out by city- or legislative district-level so far; in New York, they still haven't reported a large chunk of the vote itself yet. For those 7 states I still have them categorized by the 2016 results, but will update these with 2020 status in the future.
  • 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 188 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, November 28th (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

UPDATE: It looks like the 2022 NBPP will be open for Public Comment starting on December 4th and ending on December 30th at 5pm. This is obviously 4 days shorter than the typical 30-day minimum, and it includes Christmas Eve & Christmas Day as well. I've been informed that this is technically legal as allowing a minimum of 30 days is a guideline, not requirement...but it sure wouldn't look good if the rule is brought in front of a judge.

The Affordable Care Act includes a long list of codified instructions about what's required under the law. However, like any major piece of legislation, many of the specific details are left up to the agency responsible for implementing the law.

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 Three, November 15 - November 21, 2020

In Week Three of the 2021 Open Enrollment period, 758,421 people selected plans using the HealthCare.gov 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 HealthCare.gov 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 HealthCare.gov or CuidadoDeSalud.gov.

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.

"Picture 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 while New York and New Jersey are still far above every other state, other states are quickly catching up...and the trajectories of both North & South Dakota are incredibly disturbing in particular.

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