House Democrats on Monday passed a bill that would bolster the Affordable Care Act by hiking premium subsidies and incentivizing states to expand Medicaid.
UPDATE 9/29/20: There have been several important developments in the #TexasFoldEm case since I posted this back in June.
For one thing, another 81,000 Americans have died of COVID-19 and another 4.7 million Americans have tested positive for it.
For another, Supreme Court Justice Ruth Bader Ginsburg has passed away, and Donald Trump has already formally nominated an ultra-right wing zealot who is on the record as wanting the ACA to be struck down to replace her. His nominee's confirmation hearings have already been scheduled to start in mid-October, meaning that there's a very good chance that she'll be confirmed by the GOP-controlled Senate before Election Day...in which case the Texas Fold'em case to strike down the entire ACA could end up being the very first case she hears as a U.S. Supreme Court Justice on November 10th.
With this in mind, I figured this would be a good time to re-up the analysis below.
Here's my weekly update of the spread of COVID-19 across all 50 states, DC & PR over time, from March 20th through June 27th, 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.
I've highlighted the three states with the ugliest increases in per capit cases over the past week or so (Arizona, Florida and Texas), along with New York and Michigan for reference.
Click the image itself for a high-resolution version.
Note: The sudden jumps in New York and Massachusetts reflect reporting methodology changes; MA 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.
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:
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 Saturday, June 27th:
Yesterday, the Trump Administration formally submitted their official brief with the Supreme Court of the United States asking SCOTUS to completely and fully strike down the entire Patient Protection & Affordable Care Act. This is the latest development in the utterly insane "California vs. Texas" lawsuit (formerly "Texas vs. U.S.", "Texas vs. Azar", or as I prefer to label it, "Texas Fold'em", a name originally coined by U of M law professor Nicholas Bagley but which doesn't seem to have caught on with anyone other than me so far.
I've written about this completely absurd lawsuit more times than I care to remember, but as a reminder, here's what it comes down to.
The image below is the "3-legged stool" of the Affordable Care Act.
The blue leg represents the various patient protections which the ACA requires health insurance carriers to provide--guaranteed issue, community rating, essential health benefits and so on.
For the past few months, I've been keeping track, to the best of my ability, of how many people have been enrolling in ACA exchange policies utilizing the COVID-19-specific Special Enrollment Periods which have been offered by 12 of the 13 state-based exchanges (SBEs). My most recent update brings the grand total of confirmed SEP enrollments to at least 260,000 across 8 states, averaging around 3,500 per day.
The actual number is obviously higher than this, of course, since I don't have any data from the other four state exchanges (DC, New York, Rhode Island and Vermont), although three of those four are pretty small anyway...and even in New York, their unique "Essential Plan" (the Basic Health Plan program established under the ACA itself) has likely been sucking up the bulk of individual market enrollees earning up to 200% FPL anyway...and you can enroll in the Essential Plan year-round regardless of the pandemic. I therefore doubt that NY's COVID SEP numbers for those earning more than 200% FPL are that dramatic. All told, I'd expect NY, RI, VT & DC to only add perhaps another 25,000 or so QHP enrollees to the table below:
Nothing remotely surprising here, but it's still good to remind people of what sort of "healthcare plans" would run rampant if the ACA is struck down by the GOP's lawsuit this fall:
E&C Investigation Finds Millions of Americans Enrolled in Junk Health Insurance Plans that Are Bad for Consumers & Fly Under the Radar of State Regulators
Investigation Uncovers Troubling Tactics to Mislead Consumers into Signing Up for These Plans & then Denying or Rescinding Coverage for Medical Care
Washington, D.C. – Energy and Commerce Chairman Frank Pallone, Jr. (D-NJ), Health Subcommittee Chairwoman Anna G. Eshoo (D-CA) and Oversight and Investigations Subcommittee Chair Diana DeGette (D-CO) today released a report on the Committee’s year-long investigation into the anti-consumer practices of Short-Term, Limited Duration Insurance (STLDI) health care plans and the insurance brokers who sell and sign people up for these junk plans.
OK, this surprised me a bit: #HR1425, the Patient Protection & Affordable Care Enhancement Act, has already received a 10-year budgetary impact score from the Congressional Budget Office. I don't think this is a formal score--the whole thing is only five pages and includes minimal text accompanying it, so it might be just a "draft" score or something. I presume that if Mitch McConnell were to shock everyone and actually give it a vote in the Senate (which won't happen), there would likely have to be a second, more elaborate scoring process done by the CBO first. Then again, perhaps not.
Anyway, in a nutshell, the CBO report on the House version of H.R. 1425 comes to the following conclusions regarding the budget impact and other, related results of the bill being implemented nationally. Keep in mind that this assumes that the bill became law and was implemented starting in 2021; the score includes the 10 year period from 2021 - 2030:
TITLE I: Lowering Healthcare Costs & Protecting People w/Pre-Existing Conditions:
OK, I don't know if I "scooped" everyone with my H.R. 1425 explainer yesterday or what, but the House Energy & Commerce Committee just now sent out an official press release announcing the bill, along with a one-page summary, more detailed explainer and the link to the text itself. It's kind of interesting to see what language they use and which sections they emphasize, espeically as compared & contrasted with my own write-up:
Health Committee Chairs Unveil Legislative Package to Make Health Care & Prescription Drugs More Affordable
Legislation Also Expands Access to Health Care, Protects People with Pre-Existing Conditions & Reverses Administration’s Ongoing Sabotage of the ACA
Health Connector extends enrollment an additional month to July 23rd for uninsured individuals
On June 22, 2020, the Health Connector announced in an Administrative Bulletin an extension to the special enrollment period in response to the coronavirus (COVID-19) emergency through July 23, 2020 to assist uninsured Massachusetts residents seeking health coverage. (The extended enrollment period was previously set to end June 23.)
