Last night I threw together my very first online ACA seminar for about 40 people (plus an unknown number of Facebook Live viewers, assuming I set that up correctly). It runs about two hours; the first half was pretty much an updated version of my normal "3-Legged Stool" explainer.

For the second half, however, I was joined by University of Michigan law professor & ACA expert Nicholas Bagley who helped explain the intricacies of the absurd CA v. TX lawsuit to strike down the entire Patient Protection & Affordable Care Act (aka "TX v. Azar", "Tx. v. U.S." or, as I prefer to call it, "Texas Fold'em".

If you have two hours to kill, you can watch the whole thing here! If you want to skip past the ACA 101 stuff and go straight to Bagley & I discussing the lawsuit ahead of this morning's Supreme Court oral arguments, that starts at around the 70 minute mark.

The data below comes from the GitHub data repositories of Johns Hopkins University, except for Utah, which come 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.

Note that a few weeks ago I finally went through and separated out swing districts. I'm defining these as any county which where the difference between Donald Trump and Hillary Clinton was less than 6 percentage points either way in 2016. There's a total of 198 Swing Counties using this criteria (out of over 3,200 total), containing around 38.5 million Americans out of over 330 million nationally, or roughly 11.6% of the U.S. population.

With these updates in mind, here's the top 100 counties ranked by per capita COVID-19 cases as of Saturday, November 7th (click image for high-res version). Blue = Hillary Clinton won by more than 6 points; Orange = Donald Trump won by more than 6 points; Yellow = Swing District

Last summer, as part of my ambitious Medical Loss Ratio project, I not only broke out the exact dollar amounts and number of enrollees receiving rebates for every insurance carrier in every state in the country before the data was made publicly available, but I even took a crack at projecting just how much I expected individual market MLR rebates to be for every state in 2020 as well.

Historically, the ACA's MLR provision paid out between $100 - $400 million per year from 2012 - 2018 in rebates to individual market enrollees, averaging around $186 million per year...until last year. Here's what I originally projected 2019 payments (paid out in 2020) would likely look like last August:

If you use Anderson's 7% and assume the final, national weighted average for 2020 comes in at around 0.5%, that means roughly 6.5% of that $93.2 billion could end up having to be rebated to enrollees....or potentially 1/3 of up to $6 billion.

(updated w/latest election results)

In January 2021, the U.S. Senate will have at least 48 Democrats (including 2 Senators who caucus with the Dems) and at least 50 Republicans.

The last two seats are both in Georgia. Elected GOP Senator David Perdue was up for re-election against Democrat Jon Ossoff and a Libertarian candidate, while appointed GOP Senator Kelly Loeffler was running for the first time in a "jungle primary" against another Republican and several Democrats in a special election.

Under Georgia state law, if no candidate receives at least 50% of the vote (plus 1) in the November election, the top two finishers go on to a runoff election on January 5th.

Since no candidates in the special election came close to 50%, it will go to a runoff between Loeffler and top Democratic finisher Rev. Raphael Warnock...and the regular Senate race will also going to go to a runoff between Perdue and Ossoff, as Perdue has fallen below the 50% threshold.

9:22am Nov. 6th: See updates at end

Welp.

There's still millions of ballots left to count, and no doubt some legal battles gearing up, but as of 11:00am on November 4th, the most likely scenario going into 2021 will be:

  • Joe Biden will be sworn in as the 46th President of the United States.
  • Democrats will continue to control the U.S. House of Representatives, albeit with a smaller margin than they have today.
  • Republicans will continue to control the U.S. Senate, albeit with a smaller margin than today (either 52-48 or possilbly 51-49 depending on an upcoming runoff election in Georgia).

The Texas Fold'em lawsuit (official name: CA v. TX, formerly TX v. Azar) is scheduled to be heard by the U.S. Supreme Court (6-3 conservative) just 6 days from today, on November 10th.

Keep in mind, however, that while the hearing will happen next week, their actual decision isn't expected to be announced until next spring...most likely between April and June.

I'm about to leave to start my shift as a poll worker in this, the most important U.S. election of our lives. I've been told I might be working until as late as midnight or even later, and will likely be sequestered all day, so I won't be able to update this site or social media.

Anyway, if you haven't voted yet, VOTE TODAY.

Use this link to find out where to vote, where to drop off an absentee ballot, make sure you're registered (or register if same-day registration is allowed) and so on: iwillvote.com.

Call 1-866-OUR-VOTE or use this link to report any problems with voting, intimidation, suppression etc: 866ourvote.org.

 

The data below comes from the GitHub data repositories of Johns Hopkins University, except for Utah, which come 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.

Note that a few weeks ago I finally went through and separated out swing districts. I'm defining these as any county which where the difference between Donald Trump and Hillary Clinton was less than 6 percentage points either way in 2016. There's a total of 198 Swing Counties using this criteria (out of over 3,200 total), containing around 38.5 million Americans out of over 330 million nationally, or roughly 11.6% of the U.S. population.

With these updates in mind, here's the top 100 counties ranked by per capita COVID-19 cases as of Saturday, October 31st (click image for high-res version). Blue = Hillary Clinton won by more than 6 points; Orange = Donald Trump won by more than 6 points; Yellow = Swing District

There's a lot on everyone's plate at the moment. A global pandemic which has already killed over 230,000 Americans and infected 9 million more. The entire West Coast is on fire while the Gulf Coast is being hit with hurricanes. And there's some sort of election coming up on Tuesday, I hear.

Meanwhile, in just eleven days the Republican-controlled Supreme Court will hear oral arguments in a case brought by Republican plaintiffs (and sided with by a Republican Justice Department) over whether the Affordable Care Act should be struck down en masse because a Republican-controlled House and Republican-controlled Senate decided to change the individual mandate penalty amount from $695 to $0.

However, there's one other important thing happening with the ACA in just two days: The 2021 ACA Open Enrollment Period begins on Sunday, November 1st.

As I do every year, here's a list of important things to remember when selecting a health insurance policy. Some of these are the same every year and apply nationwide; others are specific to the 2021 enrollment period and/or to particular states.

1. DON'T MISS THE DEADLINE!

Normally Rhode Island's Open Enrollment Period deadline ends on New Year's Eve (already 2 weeks longer than the federal OEP). This year they're bumping it out even longer:

HealthSource RI extending Open Enrollment period to help more Rhode Islanders get health coverage for 2021

OK, right after saying I was putting a lid on my 2021 Rate Change project, I'm slipping in one more: The District of Columbia posted their approved rate changes a few weeks back:

Information About Approved Rates for January 2021 Health Plan Offerings on DC Health Link

Open Enrollment for Plan Year 2021 DC Health Link’s open enrollment begins November 1, 2020 through January 31, 2021. DC Health Link is an online marketplace created for individuals, families, and small business owners in the District of Columbia to shop, compare, and select health insurance that meets their health needs and budgets. For more information, visit dchealthlink.com or call (855) 532-5465.

This page contains approved health plan rate information for the District of Columbia’s health insurance marketplace, DC Health Link, for plan year 2021.

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