I just received confirmation from Vermont Health Connect that they're joining nearly every other state in offering an official COVID-19 Special Enrollment Period...with a few caveats:

Special Enrollment Period for Uninsured Vermonters Opens February 16, 2021

Waterbury, VT— In alignment with the Federal initiative, the State of Vermont is re-opening a special enrollment period on February 16, 2021 to offer Vermonters who do not currently have health insurance an opportunity to enroll in a qualified health plan and receive premium and cost-sharing assistance, if eligible. Intended to facilitate access to health insurance, the special enrollment period is being implemented in partnership with qualified health plan issuers, Blue Cross and Blue Shield of Vermont, MVP Health Care, and Northeast Delta Dental. To enroll, Vermonters should call the Customer Support Center at 1-855-899- 9600 Monday through Friday, 8:00AM – 4:30PM.

An unsurprising but still very welcome development in the Endgame of the ongoing #TexasFoldEm #ACA lawsuit:

NEW: Biden admin tells Supreme Court that ObamaCare remains constitutional even without a tax penalty to enforce the individual mandate—a reversal from Trump admin's position

https://t.co/pjNWCaSgf4

— John Kruzel (@johnkruzel) February 10, 2021

Here's the full text of the letter sent to the clerk of the U.S. Supreme Court by Deputy Solicitor General Edwin S. Kneedler. It's actually pretty cut & dry for this sort of legal document:

Dear Mr. Harris:

(updated 2/12/21 w/final approximate data from DC & VT)

With a 3-month COVID Enrollment Period about to launch in most states (and already ongoing in a few), this is another good point to take a look at how the official 2021 Open Enrollment Period went on a state-by-state basis.

Note that the table below still, frustratingly, only includes partial data for California and no data at all for New York or Rhode Island. I hope to have final data for several of these soon, but in the meantime this is the best I can do:

This Just In via NJ Governor Murphy and Get Covered New Jersey:

Governor Murphy Announces Health Insurance Signups In New Jersey Surpass Previous Two Years

  • Urges Residents to Get Covered During New COVID-19 Special Enrollment Period
  • 9.4% Increase in Plan Selections from 2020, Enrollment Remains Open Until May 15

TRENTON – Governor Phil Murphy today announced that health insurance signups through New Jersey’s new state-based marketplace surpassed the Open Enrollment Period for the previous two years in New Jersey. Plan selections for 2021 coverage increased 9.4 percent over last year’s Affordable Care Act Open Enrollment Period, as the state successfully expanded access to health coverage through its new state-based marketplace, Get Covered New Jersey, during its first open enrollment period.

Earlier this evening, the House Ways & Means Committee formally published the markup of nine legislative provisions which, if they all survive the process, will make up roughly half of President Biden's proposed $1.9 trillion COVID-19 relief package, aka the American Rescue Plan:

The Ways and Means’ proposals comprise half of the $1.9 trillion Democratic COVID-19 relief package

SPRINGFIELD, MA – Today, House Ways and Means Committee Chairman Richard E. Neal (D-MA) announced the Committee will consider nine legislative proposals under the budget reconciliation instructions this week as the next step in delivering COVID-19 relief to the American people. Beginning on Wednesday, February 10, 2021 at 10:00 a.m. through Friday, February 12, 2021, the Committee will markup proposals spanning from extending unemployment insurance to expanding the child tax credit to delivering another round of direct assistance to struggling Americans.

Just over a month ago, I noticed that the Washington Healthplanfinder was touting the fairly impressive launch of their new "Cascade Care" healthcare plans overall (40% of new enrollees were choosing them!)...but that completely missing from all the praise was any breakout of how many were selecting the Public Option version of "Cascade Care"...likely for a very good reason:

Let's step back a moment: There's actually up to three types of policies being offered depending on the carrier:

  • Qualified Health Plans (QHPs)...these are the normal policies which comply with ACA regulations offered by most carriers.
  • Cascade (Standard)...these are QHPs which also follow another state law passed last year (see below), and
  • Cascade (Select)...these are Standardized QHPs which are also public option plans.

Here's the distinction between Cascade "standard" and Cascade "select":

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, February 5th, 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

A picture is worth 1,000 words and all that.

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.

1 out of every 8 residents of North & South Dakota's entire populations have tested positive for COVID-19 over the past year.

Rhode Island is up to 1 out of every 9 residents.

Utah, Tennessee, Arizona, Iowa, Oklahoma and Arkansas are up to 1 out of every 10 residents.

41 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 4 U.S. territories) have now surpassed 1 out of every 20 residents having tested positive.

Last week the Washington Health Benefit Exchange released their official 2021 Open Enrollment Period report.

The "final" OEP numbers are gonna be a little fuzzy in some state-based exchanges this year, of course. Several states had OEP deadlines which extended past the federal one as usual, including some which didn't end until January 31st. Due to the ongoing COVID-19 pandemic, however, several of those states went gone ahead and bumped their deadlines out further yet, through as late as March for Maryland and New York.

Then last week, of course, the Biden Administration announced that HealthCare.Gov is re-opening enrollment for a full three months starting on February 15th, and a bunch of state exchanges scrambled to announce their own additional re-openings or extensions...some of which already overlapped with those 1/31 deadlines.

The other day I posted a detailed look at just how much various households could save in premiums if H.R. 369, Rep. Lauren Underwood's Health Care Affordability Act of 2021, were to be passed and signed into law by President Biden. I used 8 different household examples, and based the savings on the national average 2021 benchmark premium for a single 40-year old, according to the Kaiser Family Foundation.

The households I used include:

Huh...this is interesting. I noted a few weeks back that the Massachusetts Health Connector reported 11% fewer people had enrolled in Qualifying Health Plans (QHPs) for 2021 as of mid-January than they had during the 2020 Open Enrollment Period. At the time, they were running about 6% behind year over year, and attributed the enrollment drop (the first in the MA Health Connector's history since the first Open Enrollment Period back in 2013-2014) primarily to Medicaid enrollment:

Lower membership is primarily the result of decreased new enrollments rather than termination of existing members, likely due to Medicaid protections associated with the federal public health emergency.

The new Pennsylvania ACA exchange, Pennie, just issued their final official 2021 Open Enrollment report and (as expected) is also joining most other states in re-opening for a COVID-19 Enrollment Period:

Press Release – Pennie Exceeds Expectations & Extends Enrollment for COVID-19

  • As a state-based marketplace, Pennie increases new enrollment by 9.7% and raises total enrollment to nearly 338,000. Now, Pennie is offering more time to enroll in plans for those affected by COVID-19.
  • Pennsylvanians who have recently lost health coverage or have been affected by COVID-19 can visit pennie.com and enroll in a plan from February 15 through May 15.

This just in via the MA Health Connector...

February 3, 2021 – The Massachusetts Health Connector announced today a further extension of its Open Enrollment through May 23, providing residents impacted by COVID-19 the opportunity to get access to affordable, comprehensive health insurance.

The Health Connector previously announced an extension of Open Enrollment through March 23, two additional months beyond the original Jan. 23 deadline. Open Enrollment started Nov. 1, and the new deadline of May 23 aligns the Massachusetts health insurance exchange with the new open enrollment period for the federal exchange platform, healthcare.gov, which reopens Feb. 15 and remains open through May 15, and will be accompanied by a national marketing and awareness campaign.

This just in from the DC Health Link...

DC Residents Without Health Insurance Can Get Covered Now Through DC Health Link

Annual Open Enrollment is over, but DC Health Link’s COVID-19 Special Enrollment Period continues through the duration of DC’s public health emergency

(Washington, DC­­) – Uninsured District of Columbia residents have more time to enroll in health coverage for 2021. From now through the end of the COVID-19 pandemic, residents can enroll using DC Health Link’s Special Enrollment Period (SEP) for COVID-19. All DC Health Link plans cover diagnosis, treatment, testing, and vaccination for COVID-19 for free.

UPDATE: Everything below refers to HR 369, but the American Rescue Plan, HR 1319, contains a virtually identical expansion of ACA subsidies...if only for two years.

Note that under HR 1319 (AmRescuePlan), the first year would be retroactive, meaning that current ACA enrollees should receive additional subsidies dating back to January 2021, though I don't know what form that will take...rebate checks, credit towards future premiums or an extra tax refund next spring.

Over the past couple of years, one of the things I've become known for is my obsessive fixation on visually displaying how much various households would save on healthcare premiums if various ACA subsidy-boosting bills were passed compared with the current ACA subsidy structure.

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