The ACA was originally designed with the intention that all documented Americans living in all 50 states (+DC) earning up to at least 138% of the Federal Poverty Level (FPL) would be eligible for Medicaid. Unfortunately, the 2012 NFIB v. Sebelius ruling by the U.S. Supreme Court stated that Medicaid expansion under the ACA had to be left up to each individual state.
This meant that each state had to decide, whether by legislation, executive order (depending on the state) or ballot initiative, whether or not to expand the low-income public health program or not. Under the ACA, any state which does so will have 90% of the cost paid for by the federal government, while the state has to pony up the other 10% of the cost.
I just realized that while I've broken out state-level 2021 Open Enrollment data between Medicaid expansion & nonexpansion states, I haven't posted the state-level 2021 vs. 2020 data in a single table yet, so I'm rectifying that today. Note that this still only includes partial data for 5 states (CA, DC, MA, NJ & WA) and no data at all for 3 others (NY, RI, VT).
For that matter, Open Enrollment is still ongoing in either 5 or 6 states (Maryland depends on your POV...they ended OEP in December but re-launched it a few weeks ago in response to the COVID-19 pandemic).
While the data below is incomplete, this seems like a good time to see where things stand given that President Biden is widely expected to announce a re-launch of Open Enrollment tomorrow.
Last summer the Trump administration announced that they were slashing their advertising budget by 90%, from $100 million to just $10 million.
They also announced that they were slashing $23 million out of the navigator/outreach program for open enrollment.
That means they cut HealthCare.Gov's total budget by $113 million.
So my question is this: Where exactly did that money go?
For that matter, assuming HC.gov is set to bring in $300 million more this year, but doesn't plan on reinstating that $113 million for advertising/outreach, doesn't that mean they should be profiting by over $400 million? Again, if so, where is that money going?
In an news which surprises absolutely no one, this Thursday the Biden Administration is expected to officially announce a COVID-19 Special Enrollment Period at HealthCare.Gov, the federal ACA exchange which hosts enrollment for 36 states:
Thursday: ‘Health Care’ day
...The president is also slated to sign an executive order aimed at strengthening Medicaid and initiating an open enrollment period under the Affordable Care Act.
Trump frequently bragged about gutting the Affordable Care Act by rescinding the individual mandate, though Republicans were unable to fully repeal the law as promised.
Roughly two to three million people lost employer sponsored health insurance between March and September, and even families who have maintained coverage may struggle to pay premiums and afford care. Further, going into this crisis, 30 million people were without coverage, limiting their access to the health care system in the middle of a pandemic. To ensure access to health coverage, President-elect Biden is calling on Congress to subsidize continuation health coverage (COBRA) through the end of September. He is also asking Congress to expand and increase the value of the Premium Tax Credit to lower or eliminate health insurance premiums and ensure enrollees - including those who never had coverage through their jobs - will not pay more than 8.5 percent of their income for coverage.
Together, these policies would reduce premiums for more than ten million people and reduce the ranks of the uninsured by millions more.
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:
Every county except those in Alaska lists the 2020 Biden/Trump partisan lean; Alaska still uses the 2016 Clinton/Trump results. I define a "Swing District" as one where the difference between Biden & Trump was less than 6.0%. FWIW, there's just 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.
For the U.S. territories, Puerto Rico only includes the case breakout, not deaths, which are unavailable by county equivalent for some reason.
With these updates in mind, here's the top 100 counties ranked by per capita COVID-19 cases as of Friday, January 22nd, 2021 (click image for high-res version).
Blue = Joe Biden won by more than 6 points; Orange = Donald Trumpwon by more than 6 points; Yellow = Swing District
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 things are getting pretty horrible everywhere now.
North Dakota has broken 12.5% of the entire population having tested positive, or over 1 out of every 8 residents.
South Dakota is up to 11.9%, or more than 1 out of every 9 residents.
Utah, Rhode Island and Tennessee are up to 1 out of every 10 residents having tested positive.
38 states have seen at least 1 out of every 15 residents test positive.
EVERY state except New Hampshire, Washington, Oregon, Maine, Hawaii & Vermont (along with all 6 U.S. territories) have now surpassed 1 out of every 20 residents having tested positive.
Navigators play a vital role in helping consumers prepare applications to establish eligibility and enroll in coverage through the Marketplaces and potentially qualify for an insurance affordability programs. They also provide outreach and education to raise awareness about the Marketplace, and refer consumers to health insurance ombudsman and consumer assistance programs when necessary. Navigators are funded through federal grant funds and must complete comprehensive federal Navigator training, criminal background checks, and state training and registration (when applicable), prior to assisting consumers.
Nevada’s State Based Exchange enrolls nearly 82,000 Nevadans during Open Enrollment Period for 2021 coverage
Enrollment exceeds 2019 figures by nearly 6 percent
(CARSON CITY, NV) – The Silver State Health Insurance Exchange (Exchange), Nevada’s state agency that helps individuals get connected to budget-appropriate health coverage through the online marketplace, Nevada Health Link, enrolled 81,903 Nevadans during the 2020 health insurance Open Enrollment Period, connecting tens of thousands of Nevadans statewide to Affordable Care Act (ACA) compliant health plans. These enrollment figures exceed 2019’s enrollment figures by 4,493 – a 5.8 percent increase.
January 22, 2021 – The Massachusetts Health Connector announced today it is continuing Open Enrollment until March 23, providing additional time for state residents to access affordable, quality health insurance, particularly those hurt by the economic impacts of COVID-19.
With Massachusetts just having become the 3rd state where COVID-19 has killed more than 1 out of 500 residents, this isn't surprising (New York announced an Open Enrollment extension thru the end of March yesterday; New Jersey is still set to end theirs as of January 31st as of this writing Maryland, where COVID has "only" killed 1 out of 900, is extending theirs thru March 15th).
With Open Enrollment ongoing, Massachusetts residents who do not have health insurance have a new opportunity to get coverage through the Health Connector. This includes commercial plans through the ConnectorCare program, which provides help paying monthly premiums, and also offers low co-pays and no deductibles.
