UPDATE: It's official...and it'll be 90 days starting on 2/15, not 60.

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.

Back on January 14th, I noted that President Biden's proposed $1.9 trillion American Rescue Plan includes a couple of interesting ACA-specific provisions:

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 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.

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.

Here's an overview of the ACA's "Navigator" and "Certified Application Counselor (CAC)" programs:

Navigators

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.

Certified Application Counselors (CACs)

Breaking via the Nevada Health Link...

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.

This just in via the MA Health Connector...

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.

Back in November I noted that enrollment in Medicaid via ACA expansion has increased dramatically here in Michigan since the COVID-19 pandemic struck, increasing by 23% from 673,000 in February 2020 to 829,000 in November.

Today the Michigan Dept. of Insurance & Financial Services just issued the following press release:

More than 1 Million Michiganders Obtained 2021 Health Coverage from the Health Insurance Marketplace and the Healthy Michigan Plan

(LANSING, MICH) After an extensive joint outreach campaign by the Michigan Department of Insurance and Financial Services (DIFS) and the Michigan Department of Health and Human Services (MDHHS), more than 1 million Michiganders obtained health coverage for 2021 during the Health Insurance Marketplace open enrollment period or through the state’s expanded Medicaid program. 

Joseph R. Biden took office yesterday at around 11:50am (around 10 minutes ahead of the noon, I should note...I don't know if that's typical or if it was done slightly early for security reasons).

According to Worldometers, as of 1/20/21, the 50 United States & 6 U.S. Territories had officially reported 415,905 cumulative COVID-19 deaths since the first official case was reported exactly one year earlier. According to the COVID Tracking Project, the official U.S. death toll is at 398,000 people. Johns Hopkins University puts it at 408,000, and the CDC put it at just over 400,000. If you average these out, the Trump Administration concluded with around 405,000 officially diagnosed COVID-19 deaths.

This morning, CNN reported the obvious:

Not entirely unexpected, though I'm pretty irritated that they still haven't released any enrollment data to date. Via NY State of Health:

Press Release: Governor Cuomo Press Release: As Part of New York’s Ongoing Response to the COVID-19 Panedmic, Governor Cuomo Announces Open Enrollment for New Yorkers Extended Through March 31

As part of New York's ongoing response to the COVID-19 pandemic, Governor Andrew M. Cuomo today announced that the Open Enrollment Period for uninsured New Yorkers will be extended through March 31, 2021. New Yorkers can apply for coverage through NY State of Health, New York's Official Health Plan Marketplace, or directly through insurers.

Access Health CT, Connecticut's state-based ACA exchange, has updated their enrollment summary and now reports 104,946 residents have selected policies for 2021, including 19,056 new enrollees.

Last year they had a total of 107,833 QHP selections during Open Enrollment, so they end the 2021 Open Enrollment Period down 2.7% year over year.

There's no formal press release, so this total might not be official but it should be pretty close.

UPDATE: I've been sent the full powerpoint slideshow from Access Health CT's monthly board meeting, which is chock full of the details; I've pulled the most important ones:

Customer Interactions:

via Connect for Health Colorado (by email):

Nearly 180,000 Coloradans Signed Up for Health Insurance through the Marketplace 

DENVER – 179,661 Coloradans signed up for a health insurance plan by the end of the Open Enrollment period, according to preliminary data released today by Connect for Health Colorado®. This is about 8 percent above last year’s end of Open Enrollment total. 69% of the customers who enrolled in a 2021 plan qualified for financial help to reduce their monthly premium. 

“I’m pleased that so many people took advantage of this year’s enrollment period,” said Chief Executive Officer Kevin Patterson. “It’s essential that we all have health coverage in place to protect ourselves and our families this year.” 

Outside of the Open Enrollment period, Coloradans can still sign up for a health insurance plan through the Marketplace if they experience a Qualified Life Event, like losing job-based insurance, losing Health First Colorado (Medicaid) coverage or due to certain family and income changes. Residents can continue to get help signing up for coverage from certified Brokers and community-based Assisters. 

Over at Vox yesterday, Dylan Scott wrote a piece titled "The Trump presidency is over, and Obamacare is still alive" which is worth a read.

Before November 8th, 2016, I was secretly planning on shutting down (or at least mothballing) ACA Signups as soon as the 4th Open Enrollment period was over. Traffic had been gradually dropping off as people got used to the ACA & it started to fade from the headlines. My official day job as a website developer had suffered. What was supposed to have been a 6-month hobby in my spare time had turned into a full-time job, and I had lost web clients along the way. I figured it would be time to wind down ACA Signups & refocus on my web business.

nstead...well, you know what happened. On November 9th, 2016, I changed the header to this graphic, assuming that the ACA was doomed. I even registered ACASignoffs.net and redirected it to the site. I intended to keep the revised header up for 24 hours as a symbolic gesture.

Note: This is the second or third time that I'm cribbing a bit from my friend & colleague Andrew Sprung over at Xpostfactoid. If you like my healthcare policy analysis/writing style and follow me on Twitter, you should follow him at @xpostfactoid as well.

Over at Xpostfactoid, Andrew Sprung beat me to the punch by several days with an excellent two-part look at the "ACA 2.0 Hunger Games" scenario.

During the Democratic primary season, I posted a simple graph which boiled down the four major types of healthcare policy overhaul favored by the various Democratic Presidential candidates...which also largely cover the gamut of systems preferred by various Democratic members of the House and Senate.

Way back in October 2013, I launched the ACA Signups project as a light, nerdy hobby thing which was only supposed to last around six months, through the end of the first ACA Open Enrollment Period (March 31, 2014). Instead...well, let's just say that it's more than seven years later and I'm still doing this.

The reality is that The Graph itself doesn't serve a whole lot of useful function anymore. The enrollment patterns were erratic the first couple of years but have since settled into a pretty predictable...if not downright boring pattern for both the federal and state exchanges. The main reason I keep doing it each year is mostly out of tradition these days; after all, without The Graph, there wouldn't be an ACA Signups and I wouldn't have become a healthcare policy wonk in the first place.

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