Gummy Penis

Last week I reported that the GOP-controlled Missouri legislature decided to wipe their asses with their own state constitution by refusing to fund Medicaid expansion in the state despite the voters demanding they do so via a statewide ballot proposal last August:

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.

The House Budget Committee voted along party lines not to pass a bill allowing Missouri to spend $130 million of state funds and $1.6 billion in federal money to pay for the program’s expansion. Under the Affordable Care Act, the federal government picks up 90% of the tab on expanding Medicaid.

The expanded eligibility would allow estimated 230,000 additional low-income Missourians to be covered. It is set to go into effect in July after voters approved a ballot question last August with a 53% majority.

via Nevada Health Link:

The Division of Insurance (“Division”) encourages all Nevadans to take advantage of the new saving opportunities offered by the American Rescue Plan Act of 2021 (“ARPA”). The ARPA, enacted earlier this month, creates more opportunities for Nevadans to save on health insurance coverage.

“I urge consumers, especially those who have off-exchange plans, have no insurance or have found themselves uninsured to start thinking now about how they can benefit from this new law because certain benefits in the ARPA have deadlines,” said Insurance Commissioner Barbara Richardson. “Each month that a consumer does not take advantage of these new low or no cost opportunities, they are leaving money on the table.”

The ARPA will lower monthly premium costs; increase subsidy eligibility for consumers making above the 400% of the Federal Poverty Level; provide options for people who are on unemployment for $0 premium plans; and it will provide 100% COBRA subsidy for six months.

New York State of Health

It's been awhile since I've written anything about the ACA's Basic Health Plan (BHP) provision. BHP is a program which every state has the option of taking advantage of, but so far only two have: Minnesota and New York State. I'll let Louise Norris explain:

Under the ACA, most states have expanded Medicaid to people with income up to 138 percent of the poverty level. But people with incomes very close to the Medicaid eligibility cutoff frequently experience changes in income that result in switching from Medicaid to ACA’s qualified health plans (QHPs) and back. This “churning” creates fluctuating healthcare costs and premiums, and increased administrative work for the insureds, the QHP carriers and Medicaid programs.

via Amy Lotven and John Wilkerson of Inside Health Policy:

Pelosi: Drug Pricing May Pay For Health Care Pieces Of Infrastructure Bill

House Speaker Nancy Pelosi (D-CA) said everything is on the table for the next legislative package that is expected to focus on infrastructure improvements and include health care provisions like a permanent increase to the Affordable Care Act tax credits — and she said the package likely will be paid for by tackling prescription drug prices.

...Pelosi said including House Democrats’ drug pricing bill, H.R.3, would pay for $500 billion of the cost of the infrastructure bill, part of which could be used to boost ACA tax credits and make ACA coverage more affordable. The savings also could also be used for other health-related efforts, she said. For example, House Energy & Commerce Chair Frank Pallone (D-NJ) has been working with Rep. Jim Clyburn (D-SC) to expand community health centers and to improve broadband services, which would support telehealth.

Your Health Idaho, which had been scheduled to end their COVID-19 Enrollment Period on March 31st, has understandably extended the deadline out by another month in light of the American Rescue Plan's expanded/enhanced subsidies. Via email:

Enhanced Subsidies Go into Effect at Your Health Idaho April 1

Your Health Idaho Continues to Enroll Idahoans through April 30, 2021

BOISE, Idaho –Your Health Idaho, the state insurance exchange, will remain open throughout the month of April so Idahoans can take advantage of enhanced financial assistance, which lowers consumer’s monthly premiums. 

For the first time ever, tax credits, which act like an instant discount, may be available for those who were not previously eligible and will be increased for Idahoans who already receive them. For some Idahoans, these savings can be significant. For example, a Treasure Valley married couple in their 20s making $50,000 a year could pay less than $10 a month and a family of four making $105,000 could pay as little as $200 a month.

CSR

 

I honestly thought that I had written the final chapter in this absurd saga, which started two administrations, two House Speakers, three HHS Secretaries and three U.S. Attorney Generals ago when the Federal Circuit Court issued their final ruling last August, but apparently not.

Since this insanity has been grinding away for nearly seven years now, I'm pretty much just reposting my entire August entry, with an important update tacked on at the end.

Here's a quick recap:

  • The ACA includes two types of financial subsidies for individual market enrollees through the ACA exchanges (HealthCare.Gov, CoveredCA.com, etc). One program is called Advance Premium Tax Credits (APTC), which reduces monthly premiums for low- and moderate-income. APTCs are the subsidies which have been substantially beefed up by the American Rescue Plan (the additional subsidies will be available starting in April in most states, soon thereafter in most other states).
  • The other type of subsidies are called Cost Sharing Reductions (CSR), which reduce deductibles, co-pays and other out-of-pocket expenses for low-income enrollees.
  • In 2014, then-Speaker of the House John Boehner filed a lawsuit on behalf of Congressional Republicans against the Obama Administration. They had several beefs with the ACA (shocker!), including a claim that the CSR payments were unconstitutional because they weren't explicitly appropriated by Congress in the text of the Affordable Care Act (even though the program itself was described in detail, including the payment mechanism/etc.)
Platinum Blonde

In the United States, major medical insurance policies for those who don't have healthcare coverage through their employer, Medicare, Medicaid, CHIP, the Veteran's Administration or some other source are available via the ACA's individual market exchanges. The individual market for residents of 36 states is HealthCare.Gov; the remaining 14 states + DC each have their own ACA exchange, such as Covered California, NY State of Health and so forth.

There are usually dozens of ACA policies available via the ACA exchanges, but they fall into five major categories: Catastrophic, Bronze, Silver, Gold and Platinum plans (other major distinctions include HMOs vs. PPOs and other variables,but those are for another day).

With rare exceptions, Catastrophic plans are only available to enrollees under 30 years old. ACA premium subsidies can't be used to help pay for Catastrophic plans either, so enrollment is rare; during the 2020 Open Enrollment Period, only 89,000 ACA exchange enrollees selected Catastrophic plans out of over 11.4 million total, or just 0.8%.

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.

Important:

  • Every county except those in Alaska lists the 2020 Biden/Trump partisan lean; Alaska still uses the 2016 Clinton/Trump results (the 2020 Alaska results are only available by state legislative district, not by county/borough for some reason...if anyone has that info let me know)
  • I define a "Swing District" as one where the difference between Biden & Trump was less than 6.0%. FWIW, there's just 187 swing districts (out of over 3,100 total), with around 33.7 million Americans out of 332 million total, or roughly 10.2% of the U.S. population.
  • For the U.S. territories, Puerto Rico only includes the case breakout, not deaths, which are unavailable by county equivalent for some reason.

With those caveats in mind, here's the top 100 counties ranked by per capita COVID-19 cases as of Thursday, March 18th, 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 (Biden or Trump won by less than 6 points)
Gummy Penis

August 5, 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

Last summer, when activists in both Missouri and Oklahoma were preparing for this historic vote, I wrote the following:

via New York State of Health:

How NY State of Health Enrollees Benefit from the American Rescue Plan

The American Rescue Plan, which was signed into law on March 11, 2021, will lower health care costs by providing new and expanded financial assistance to New Yorkers enrolling in health insurance through NY State of Health. This enhanced assistance is available to current enrollees and new enrollees, including to higher-income individuals for the first time. Starting in early April, individuals with low and moderate incomes can access higher tax credits. Starting in June, NY State of Health will apply these higher tax credits to current enrollees without requiring any action by the enrollee. Also in June, higher-income New Yorkers can access the new tax credits.

The information on this page is organized into six sections. Click the section from the following list to learn how the American Rescue Plan can help you:

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