Note: This is a guest post by Miranda Wilgus, Executive Director and Co-Founder of ACA Consumer Advocacy (disclosure: I'm on the ACACA board of directors).

In the middle of June 2020, with over three months of an international pandemic behind us, over 100,000 Americans and more around the world dead from Covid19 and its complications, what are we waiting for? We know that our administration has done everything possible to impede the facilitation of needs and resources to our country. Special interests are running rampant, price gouging is the norm, government agencies have been scooping up supplies from states that are desperately needed, and the GOP controlled Senate is more focused on packing courts with unqualified idealogues than with passing bills to assist Americans financially affected by the pandemic.

On March 20th, the Vermont Health Connect ACA exchange joined other state-based exchanges in launching a formal COVID-19 Special Enrollment Period.

On April 15th, just ahead of the original SEP deadline, they bumped it out by a month:

Due to the COVID-19 emergency, Vermont Health Connect has opened a Special Enrollment Period until May 15, 2020. During this time, any uninsured Vermonter can sign up for a Qualified Health Plan through Vermont Health Connect. Qualified families can also get financial help paying for coverage.. Please call us at 1-855-899-9600 to learn more.

Then, with the May deadline approaching, I took a look and sure enough, they've bumped it out another month:

On March 16th, New York's ACA exchange, NY State of Health, announced that they'd be launching a COVID-19 Special Enrollment Period with a deadline of April 15th. As that date approached, in the middle of the worst pandemic to hit New York State 100 years, the deadline was extended out by a month, through May 15th.

When that deadline approached, NY Governor Andrew Cuomo ordered the COVID-19 SEP to be bumped out by another month.

And now, with the June 15th deadline having come and gone, lo and behold:

Governor Andrew M. Cuomo today announced low-risk youth sports for regions in phase three of reopening can begin on July 6th with up to two spectators allowed per child. 

For several years now, I've been urging Congress to upgrade the Affordable Care Act via a series of major improvements. Most notable among these is the need to #KillTheCliff...that is, to eliminate the so-called "Subsidy Cliff" which kicks in for ACA individual market enrollees who earn more than 400% of the Federal Poverty Line (roughly $50,000 for a single adult or $103,000 for a family of four).

As I've explained many tmes, the ACA's subsidy structure works pretty well for those earning between 100 - 200% FPL, and is at least acceptable for those earning 200 - 400% FPL (in fact, thanks to #SilverLoading, it works quite well for most of that population as well). The real problem kicks in above 400% FPL (and to a lesser extent below 138% FPL for those living in the 14 states which still haven't expanded Medicaid). In addition, the subsidy formula still doesn't make policies truly affordable for many of those receiving them.

In short, both the upper- & lower-bound Subsidy Cliffs need to be eliminated, and the underlying formula needs to be strengthened as well.

Now that I've brought all 50 states (+DC & the U.S. territories) up to date, I'm going to be posting a weekly ranking of the 40 U.S. counties (or county equivalents) with the highest per capita official COVID-19 cases and fatalities.

Again, I've separates the states into two separate spreadsheets:

• Alabama - Missouri can be found here
• Montana - Wyoming can be found here

Most of the data comes from either the GitHub data repositories of either Johns Hopkins University or the New York Times. Some of the data comes directly from state health department websites.

Here's the top 40 counties ranked by per capita COVID-19 cases as of Sunday, June 14th:

As promised, here's my weekly update of the spread of COVID-19 across all 50 states, DC & PR over time, from March 20th through June 14th, 2020, in official cases per thousand residents.

I've given up trying to tie every trend line to the state name; it simply gets too crowded near the bottom even with a small font size, so I've grouped some of them together where necessary.

Note that this graph doesn't take into account any of the rumored undercounts in Florida, Georgia etc...these are based on the official reports from the various state health departments. If and when those are ever modified retroactively I'll update the data accordingly.

Click the image itself for a high-resolution version.

Note: The sudden jumps in New York, Massachusetts and Michigan all reflect reporting methodology changes; MA & MI started including probable COVID-19 cases, while New York added a batch of 15,000 positive antibody tests results they hadn't been previously including.

Hardly surprising given how vile the current administration is about everything else, but still a bit of a break from the All-COVID-19/BLM Protests, All The Time news of late. Via Dan Diamond of Politico:

The Trump administration on Friday formally rolled back an Obama-era policy that protected LGBTQ patients from discrimination and required robust language translation services, unnerving health experts who worry vulnerable populations will face further risks during the Covid-19 pandemic.

The move — long sought by some of President Donald Trump's supporters in the conservative Christian community — is the latest effort by Trump to mobilize his religious base amid criticism over his handling of the coronavirus outbreak and the recent protests over the death of George Floyd in police custody.

On April 14th, Covered California reported that 58,000 residents had enrolled in ACA exchange coverage during their COVID-19 Special Enrollment Period, of which roughly 20,000 did so via standard SEPs (losing coverage, moving, getting married/divorced, etc), while an additional 38,000 took advantage of the COVID-specific SEP.

On April 28th, they announced that the number was up to 84,000 new ACA exchange enrollees, averaging around 2.5x as many as enrolled via standard Special Enrollment Periods during the same period a year ago.

On May 20th, they announced the total was up to 123,000 new ACA exchange enrollees via the COVID SEP, "nearly" 2.5x the rate of a year before.

A lifetime ago (well, mid-February of this year, anyway), I wrote about New Mexico's Health Care Affordability Fund (HB 278), a bill which easily passed through the state House...only to be inexplicably stopped in its tracks in the state Senate a few days later.

The bill in question wasn't terribly complicated; it essentially just placed a new fee on health insurance carriers to finance a new fund which would in turn be used to reduce healthcare coverage costs for low- and middle-income New Mexicans. Furthermore, since some of the fees would be imposed on managed Medicaid programs which are mostly federally funded, it would have leveraged tens of millions of dollars in federal funding as opposed to all of the fees coming from state residents. Had it gone into effect, HB 278 was expected to generate around $125 million in revenue for the state to use to reduce premiums and cost sharing for enrollees.

via the Maryland Health Benefit Exchange:

NEARLY 40,000 MARYLANDERS HAVE ENROLLED DURING CORONAVIRUS EMERGENCY SPECIAL ENROLLMENT PERIOD

• Less than a week left for uninsured residents to get marketplace coverage

BALTIMORE, MD – The Maryland Health Benefit Exchange today is urging uninsured Marylanders to enroll in coverage before the June 15 deadline through the state’s health insurance marketplace, Maryland Health Connection, under the Coronavirus Emergency Special Enrollment Period. To date, nearly 40,000 residents have received health coverage during this special enrollment period that began in March with Gov. Larry Hogan’s announcement of a State of Emergency in Maryland.