Charles Gaba's blog

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, December 25th (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 their surge seems to be finally dropping (although "dropping" is a relative term...it's still pretty awful everywhere).

North and South Dakota are the first two states where more than 10% of the entire population has tested positive (in fact, North Dakota is about to hit 12%). A few other states could all potentially hit the 10% milestone by New Year's Eve as well.

UPDATE 12/31/20: The deadline to submit public comments has passed. In the end, there are 320 comments, 243 of which were submitted after I posted this entry. The wording on a random check of some finds that at least a couple dozen appear to have been guided by my own sample comment below, which I'm glad to see.

Now we'll just have to wait and see. Thank you to everyone who helped out!

Last month, I wrote about the annual Notice of Benefit & Payment Parameters for 2022 (NBPP) from the Centers for Medicare & Medicaid (CMS). This is a long, wonky document published each year which includes a bunch of proposed modifications to various aspects of how the ACA is administered and implemented.

Some of the proposed changes each year are pretty much mandatory. Some are completely up to whoever is running CMS/HHS at the time. Some are nominal tweaks; some are major changes.

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.

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):

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