Regular readers have no doubt noticed that something like 80% of the new posts here at ACA Signups over the past 2-3 weeks have been obsessively tracking COVID-19 vaccination rates via various metrics (partisanship, income, geographic region, education level, etc). While COVID and the vaccination program are obviously heavily healthcare policy-related, they're also obviously not right at the core of what this site is normally about.

This week I'm finally easing off on the vaccination tracking stuff (I'll only be posting about them here weekly going forward--on Wednesdays--with rare exceptions), I wanted to explain why I've been so obsessive about this. A Twitter thread by nurse Julia Pulver (an old friend of mine here in Michigan) explains it better than I could. I've converted her thread into a more blog-friendly format with her permission:

One of the most traumatic experiences I ever had in an ICU was performing end of life care for a 34yr mother of 3. She had advanced breast cancer & there was nothing more that could be done-she was in multi-system organ failure.

NOTE: The original version of this post included a serious, bone-headed data error on my part, requiring me to pull the post and revamp it just minutes after it went live. After the main post I'll explain how I screwed up and how I've resolved the issue. The bottom line is that my premise may still be correct, but if so it won't be nearly as dramatically as I had originally thought.

As I noted a week ago, something very interesting has changed on the GOP side of the political and media punditry aisle:

Generally speaking, however, it sure sounds to me like someone in the GOP now believes that their 6-month anti-vaxx propaganda campaign is starting to kill off their own voter base, because everyone from Sean Hannity to Florida Governor Ron "Don't Fauci my Florida" DeSantis seem to have finally gotten the memo.

Today I'm looking at county-level U.S. vaccination rates via two other factors: Income and Education.

For Income, I'm using the USDA Economic Research Service's estimate of Median Household Income from 2019 (which was, of course, the last year before COVID-19 hit the U.S. in the first place).

The lowest countywide median household income in 2019 was around $25,000/year (Clay County, Georgia); the highest was roughly $152,000/year (Loudoun County, Virginia):

One of the biggest criticisms I've received with my county-level vaccination level project is that I haven't taken into account a rather obvious truth about the partisan divide in America: Democrats tend to cluster in much more densely-populated urban areas while Republicans tend to live in more sparsely-populated rural areas.

In addition, regardless of your political lean, you might expect it to be a lot more difficult to get vaccinated if you live out in the middle of the boonies where the nearest hospital, clinic or pharmacy is 50 miles away or whatever...not to mention that if you're the only one for miles around, you might be less likely to see getting vaccinated as a high-priority task regardless of your ideology.

Therefore, the reasoning goes, instead of looking at the partisan lean of each county, it would make much more sense to see how much correlation there is based on population density or whether it's a more urban or rural region, right?

Fair enough. I decided to do just that:

I was planning on only updating the county-level vaccination graph monthly, but given the attention this has received via high-profile folks like David Frum and Paul Krugman, I've decided to post updates weekly.

With the more aggressive Delta variant now spreading quickly among the unvaccinated in the U.S., 85% of the total population seems to indeed be the more likely threshold which will be needed to achieve herd immunity.

As a reminder:

Every year, I spend months tracking every insurance carrier rate filing for the following year to determine just how much average insurance policy premiums on the individual market are projected to increase or decrease.

Carriers tendency to jump in and out of the market, repeatedly revise their requests, and the confusing blizzard of actual filing forms sometimes make it next to impossible to find the specific data I need. The actual data I need to compile my estimates are actually fairly simple, however. I really only need three pieces of information for each carrier:

How many effectuated enrollees they have enrolled in ACA-compliant individual market policies;

What their average projected premium rate change is for those enrollees (assuming 100% of them renew their existing policies, of course); and

Ideally, a breakout of the reasons behind those rate changes, since there's usually more than one.

Usually I begin this process in late April or early May, but this year I've been swamped with other spring/summer projects: My state-by-state Medicaid Enrollment project and my state/county-level COVID-19 vaccination rate project.

Every year, I spend months tracking every insurance carrier rate filing for the following year to determine just how much average insurance policy premiums on the individual market are projected to increase or decrease.

Carriers tendency to jump in and out of the market, repeatedly revise their requests, and the confusing blizzard of actual filing forms sometimes make it next to impossible to find the specific data I need. The actual data I need to compile my estimates are actually fairly simple, however. I really only need three pieces of information for each carrier:

How many effectuated enrollees they have enrolled in ACA-compliant individual market policies;

What their average projected premium rate change is for those enrollees (assuming 100% of them renew their existing policies, of course); and

Ideally, a breakout of the reasons behind those rate changes, since there's usually more than one.

Usually I begin this process in late April or early May, but this year I've been swamped with other spring/summer projects: My state-by-state Medicaid Enrollment project and my state/county-level COVID-19 vaccination rate project.

via CMS:

HHS Encourages States to Educate Eligible Immigrants about Medicaid Coverage

Today, the US Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS) issued an informational bulletin to states’ Medicaid and Children’s Health Insurance Program (CHIP) agencies reaffirming that the 2019 Public Charge Final Rule – “Inadmissibility on Public Charge Grounds” – is no longer in effect and states should encourage their eligible immigrant populations to access public benefits related to health and housing. 

Let's be clear: There's a good ~48 million or so children under age 12 who haven't been approved to take the COVID-19 vaccine yet, roughly 14% of the population. There's also perhaps 8 - 9 million Americans age 12+ who are immunocompromised or have serious allergic reactions to vaccinations, meaning the vaccine would have no effect on them or they can't take it at all. Combined, that's around 17% of the total U.S. population who can't get vaccinated, leaving it up to the other 83% of us who can to do so.

August 2020:

We did it!

Missouri just voted #YesOn2 to expand Medicaid, and now, because of YOUR vote, over 230,000 hardworking people will have access to life-saving healthcare! pic.twitter.com/azHN0GJjEW

— YesOn2: Healthcare for Missouri (@YesOn2MO) August 5, 2020

March 2021:

Republican lawmakers blocked Medicaid expansion funding from reaching the Missouri House floor on Wednesday, posing a setback for the voter-approved plan to increase eligibility for the state health care program.