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The Affordable Care Act includes a long list of codified instructions about what's required under the law. However, like any major piece of legislation, many of the specific details are left up to the agency responsible for implementing the law.

While the PPACA is itself a lengthy document, it would have to be several times longer yet in order to cover every conceivable detail involved in operating the ACA exchanges, Medicaid expansion and so forth. The major provisions of the ACA fall under the Department of Health & Human Services (HHS), and within that, the Centers for Medicare & Medicaid (CMS)

Every year, CMS issues a long, wonky document called the Notice of Benefit & Payment Parameters (NBPP) for the Affordable Care Act. This is basically a list of proposed tweaks to some of the specifics of how the ACA is actually implemented.

For example, here's what the actual PPACA legislative text itself said about the annual Open Enrollment Period (OEP):

(6) Enrollment periods.--The Secretary shall require an Exchange to provide for--

National Center for Health Statistics

NOTE: See important updates towards the bottom, including age-adjusted versions of both the monthly & cumulative graphs.

Back in August, a very smart & savvy Twitter friend of mine who goes by the name of Propane Jane started a thread about the racial (and racist) aspects of the COVID pandemic response, both in terms of infection, death & vaccination rates as well as other societal policies like in-person schools, mask mandates and so forth. It's a great thread and I highly recommend reading the whole thing, which starts here.

She's continued to update the thread from time to time (the most recent update was on November 30th), but there was one tweet mid-thread which caught my eye the other day:

Covered California Logo

via Covered California:

  • Covered California’s first open-enrollment deadline is this week: People need to sign up by Dec. 31 in order to have their coverage start on Jan. 1.
  • The deadline comes as the omicron variant is spreading across California, with the average cost of COVID-related hospitalizations and ICU care at $127,000, underscoring the importance of having insurance to avoid medical debt.
  • Having health care coverage, staying COVID-safe and getting vaccines and booster shots are critical to protecting your health and the health of your family and community.
  • An estimated 1.1 million Californians are uninsured and eligible for financial help from Covered California or Medi-Cal, and the majority could get comprehensive coverage at no cost.

La versión en español de este Comunicado puede ser descargada en este enlace

Your Health Idaho Logo

Idaho is unique among the 50 U.S. states + DC this year in that it's the only one whose ACA exchange ended their 2022 Open Enrollment Period (OEP) before the official January 15th final deadline set by the Biden Administration.

Your Health Idaho was originally going to stick with December 15th as their final Open Enrollment deadline (most states made 12/15 the deadline for January coverage, but are giving residents until 1/15 to enroll for coverage starting in February). They ended up extending that deadline out until December 22nd in the end, but that's it--going forward, Idahoans will only be eligible for ACA coverage if they become eligible thanks to a Qualifying Life Event (QLE) such as losing their existing coverage, moving to a different rating area, turning 26 and so on.

In any event, even without the January final deadline, YHI still managed to beat last year's enrollment numbers by 6.6%:

Here are the OE 2022 numbers with year over year change included (the YoY is Dec. 22, 2021 vs Dec. 31, 2020).


Here's the weekly look at the rate of COVID-19 cases & deaths at the county level since the end of June, broken out by partisan lean (i.e, what percent of the vote Donald Trump received in 2020).

As always:

The partisan ratio of case rates are now only running 2.0x higher per capita in the reddest tenth of the country than the bluest tenth, down from 3.0x higher in late October and from 2.4x higher just a week ago:

COVID-19 Vaccine

Methodology reminders:

  • I go by county residents who have received the 2nd COVID-19 shot only (or 1st in the case of the J&J vaccine).
    • (data for 3rd/booster shots aren't available at the county level in most states yet)
  • I base my percentages on the total population via the 2020 U.S. Census as opposed to adults only or those over 11 years old (or even over 4 years old).
  • For most states + DC I use the daily data from the Centers for Disease Control, but there are some where the CDC is either missing county-level data entirely or where the CDC data is less than 90% complete at the county level. Therefore:
    • For Vermont, Virginia and West Virginia, I'm using data from the COVID Act Now Risk & Vaccine Tracker database
      • NOTE: There's several counties in Virginia where I'm using the official state health department dashboard instead this week specifically due to some weirdness in the COVID Act Now data. If these issues continue I may have to switch to the state dashboard for all counties for VA going forward, which would be a royal pain given the inability to export every county at once.
Access Health CT Logo

Via Access Health CT's News/Press Releases page:

Stats as of December 23, 2021

Qualified Health Plans (QHP):

  • QHP Enrollment In 2022 Coverage: 104,983
  • 2022 OE Acquisition Summary: 12,907


  • Completed applications/redeterminations processed through the integrated eligibility system: 17,280

I'm not entirely sure what the 12,907 figure refers to, but I've confirmed that it's already included in the larger number.

Last year's final OEP enrollment tally for Connecticut was 104,946 QHP selections, which they just surpassed...with over 3 weeks left for CT residents to get covered (they have until New Year's Eve to enroll for coverage starting January 1st, and from January 1st - January 15th for coverage starting February 1st).

BeWellNM Logo

This just in via BeWell NM, New Mexico's just-launched state-based ACA exchange website:

BeWellnm Health Insurance Enrollment Deadline Extended

  • New Mexicans Have Until December 31, 2021 to Enroll in Comprehensive and Affordable Health Care Coverage Beginning January 1, 2022

Albuquerque, N.M. (December 23, 2021) – Beginning today, beWellnm, the New Mexico Health Insurance Exchange, is extending its enrollment period and premium payments for effective coverage beginning January 1, 2022. New Mexicans now have until December 31, 2021 to enroll and pay their premium to receive coverage for Plan Year 2022 starting the first of the year. New Mexico residents who would prefer to have effective coverage beginning February 1, 2022 still have until January 15, 2022 to enroll.

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A month ago, I made what seemed to be a reasonable prediction based on the data available at the time:

That would put the national final QHP total at somewhere between 12.9 - 13.2 million people nationally as of January 31st, 2022; call it around 13.1 million.

...I completely forgot to mention BASIC HEALTH PLAN (BHP) enrollment in New York and Minnesota. It totalled 975,337 people during the 2021 OEP (883,451 in New York, 91,886 in Minnesota)...I'm willing to bet total BHP enrollment across both states will end up perhaps 10% higher year over year, which would put it at around 1.1 million.

When you add that to my QHP projection above, you get a grand total of perhaps 14.1 million QHPs + BHPs combined.

If this projection had proven accurate, it would have meant total ACA exchange enrollment was up ~9 - 10% year over year, which would have been impressive but not stellar.

HealthCare.Gov Logo

Hot off the presses, via the Centers for Medicare & Medicaid:

Week 6, December 5 - December 15, 2021

In week 6 of the 2022 Open Enrollment Period, approximately 5.8 million people selected individual market plans or were automatically re-enrolled in a plan through the 33 states that use the platform. During the Open Enrollment Period, to date, approximately 9.7 million people have selected individual market plans or were automatically re-enrolled in a plan through While past snapshots this year have measured enrollment weeks Sunday through Saturday, this week’s snapshot for week six also includes the final few days prior to the deadline for January 1 coverage.