I first wrote about Laura Packard here 3 1/2 years ago when she was first diagnosed with Hodgkins, though I've known her personally for a good 15 years or so. When she was diagnosed, her outlook was bleak; fortunately, she has since recovered and is now doing great:

In the spring of 2017, I was diagnosed with cancer (stage 4 Hodgkin’s Lymphoma). After a grueling 6 months of chemotherapy and a month of radiation treatment, I am in remission. For now. Hopefully forever.

The Affordable Care Act saved my life. But all the time I was fighting cancer, I had to fight my own U.S. Senator and my President in order to keep my health insurance. The day after my first chemotherapy session, the Republican House voted to dismantle the ACA. The “skinny repeal” of Obamacare was voted down in the Senate by one vote a couple days before my 7th chemo session. And the day after my 15th radiation session, I was thrown out of my (former!) U.S. Senator’s public forum for asking him about his health care record.

via the Washington Health Benefit Exchange:

Washington Healthplanfinder Sees Surge in Customers as Final 2021 Deadline Approaches

  • Select a plan by Jan. 15 for coverage that begins Feb. 1

People statewide flocked to Washington Healthplanfinder this week to beat the Dec. 15 deadline for health coverage that would start the first of the year. With that date now passed, Washingtonians still seeking 2021 health coverage have until Jan 15, 2021 to shop on Washington Healthplanfinder for coverage that begins February 1.

“We were glad to see the large number of enrollees come in and secure coverage that starts Jan. 1,” said Chief Executive Officer Pam MacEwan. “This year, in response to the public health emergency, we are providing additional time for those who didn’t enroll prior to Dec. 15 to sign up for 2021 coverage over the next month.”

A few weeks ago, Amy Lotven of Inside Health Policy reported on a clerical problem caused by a COVID-induced backlog at the IRS:

According to IRS National Taxpayer Advocate Erin Collins, IRS sent 1.8 million letters seeking more information from taxpayers who either failed to reconcile their tax credits or had discrepancies on their forms this year. But staff cuts and other problems stemming from the pandemic have stymied IRS’ work, and the agency still has about 1 million returns waiting to be processed, 3 million pieces of unopened mail and about 6.8 million individual returns still in process. As a result, even if taxpayers provided all requested information, the data that IRS shared with the marketplace might be inaccurate or incomplete, Collins says in a Nov. 25 blog published by the IRS’ Taxpayer Advocacy Service.

It's turned into an annual tradition: The official annual ACA Open Enrollment Period (OEP) runs from November 1st - December 15th, but most of the state-based ACA exchanges have later deadlines. hThen, right around the 12/15 point, it begins: One by one, some of the state-based exchanges announce further extensions of their deadlines to #GetCovered for the upcoming year.

In some cases they simply bump out the deadline for coverage starting in January, with the final "hard" deadline for February or March coverage staying where it is. In other cases they were never allowing Open Enrollment start dates past January to begin with, so it's the hard deadline which is being extended.

In any event, here's this year's batch of announcements; note that this list could grow longer over the next week or two:

via Access Health CT:

Access Health CT Extends 2021 Annual Open Enrollment Period As A Result Of Current Health Crisis

CT residents can shop and enroll in health insurance coverage until January 15, 2021

  • Access Health CT extended the 2021 Annual Open Enrollment period until January 15, 2021 as a result of the current health crisis, providing more time for CT residents to get covered.
  • If individuals choose a plan during the extension, the coverage will start on February 1, 2021.
  • If customers are already covered by an insurance plan through Access Health CT for January 2021 and would like to pick a new plan starting in February 2021, they must first pay their January monthly bill (premium).

HARTFORD, Conn. (December 16, 2020)—Access Health CT (AHCT) today announced an extension for the 2021 Annual Open Enrollment period until January 15, 2021 as a result of the current health crisis, providing more time for CT residents to get covered.

via Connect for Health Colorado:

Connect for Health Colorado Offers Coloradans Through Dec. 18 to Enroll in Health Insurance Starting Jan. 1

DENVER — To help as many people as possible sign up for health insurance that begins on the first day of 2021, Connect for Health Colorado has decided to extend the deadline for January 1 coverage to this Friday, Dec. 18.

“Too many Coloradans have been left unemployed, uninsured and are struggling to get by as the pandemic grows,” said Chief Executive Officer Kevin Patterson. “By giving people a few extra days this week to get the coverage they need right on January 1st, we can ease some of the strain people are feeling. Financial help is available to reduce costs and local experts can also provide free enrollment assistance.”

Access Lower Premiums and Health Care Costs

Last week, Get Covered New Jersey, NJ's brand-new state-based ACA exchange, reminded New Jersey residents to enroll via Open Enrollment via the #GetCovered2021 campaign. The press release also mentioned, in passing, that nearly 227,000 NJ residents have already signed up for 2021, over 20,000 of whom are new enrollees.

Today, they posted a much more detailed breakout of their enrollment data so far, as well as reminding residents that unlike most states, New Jersey's Open Enrollment Period isn't over until the end of January, although they have to enroll by December 31st for coverage starting January 1st:

There's no formal press release, but Pennie, Pennsylvania's brand-new state-based ACA exchange just noted via their official Twitter account that they're extending the enrollment deadline for coverage starting January 1st by one week:

IMPORTANT ANNOUNCEMENT! We have extended the deadline! You now have until Tuesday, December 22 to select health coverage that begins New Year’s Day.

— Pennie (@PennieOfficial) December 15, 2020

A reminder from MNsure, Minnesota's ACA exchange:

The Final Countdown; MNsure's Open Enrollment Period Ends December 22 at Midnight

ST. PAUL, Minn.—Minnesotans looking for health insurance coverage starting January 1, 2021, have until 11:59 p.m. on Tuesday, December 22 to enroll in coverage through MNsure.org. The federal health insurance exchange, HealthCare.gov, ends its enrollment period today, but Minnesotans have an extra week to enroll through MNsure.

"There is still time to get 2021 health care coverage through MNsure," said MNsure CEO Nate Clark. "Minnesotans have through December 22 to sign up for comprehensive health insurance and access the financial help that makes it more affordable. But, don’t wait! Visit MNsure.org today so you can be sure you’re covered in the new year."

Need help? MNsure's Contact Center will provide extended hours leading up to the deadline:

via the Washington Health Benefit Exchange:

Washington Healthplanfinder Urges Customers to Act Now for Jan. 1 Health Coverage

  • People need to enroll in their desired 2021 health plan by midnight, Tuesday Dec. 15

Washington Healthplanfinder is urging individuals needing 2021 health and dental coverage beginning Jan. 1 that they have less than 36 hours to take action and sign up. Customers wanting coverage that starts Jan.1 must select a plan through Washington Healthplanfinder by 11:59 p.m. this Tuesday, Dec. 15.

“For those who have left this decision to the last minute, now is the time to sign up for 2021 health and dental coverage,” said the Exchange Chief Executive Officer Pam MacEwan. “There are plenty of resources available to help people understand their options and secure health insurance coverage.”

via the Nevada Health Link:

While most of the country’s Exchanges prepare to conclude their Open Enrollment Periods, Nevada Health Link remains open through January 15, 2021 to purchase 2021 coverage

  • Nevadans have 30 more days to get covered Nearly 72,000 Nevadans have enrolled to date

Carson City, Nev. – While most of the country prepares to conclude their open enrollment periods s this week on Dec. 15, Nevadans have an additional 30 days to enroll in health insurance coverage for 2021. Now through Jan. 15, 2021, Nevada Health Link, the online health insurance marketplace operated by the Silver State Health Insurance Exchange (Exchange), remains open and available for Nevadans to purchase comprehensive, Affordable Care Act (ACA) compliant health plans for 2021. As a State Based Exchange (SBE), Nevada Health Link makes its own decisions and is autonomous from the federal marketplace – HealthCare.gov – therefore allowing for an extended Open Enrollment Period (OEP), which is one of the many advantages to operating as a SBE.

This letter was sent to CMS Administrator Seema Verma over the weekend by Peter Lee, Executive Director of Covered California:

Dear Administrator Verma:

The COVID-19 pandemic continues to surge across the nation, endangering Americans and filling our hospitals from coast to coast. In the middle of this rising crisis, nearly 80 percent of the health insurance marketplaces, including all of those supported by the federally facilitated exchange (FFE) and a small number of state-based exchanges, are set to close their open-enrollment periods on December 15th.

We are writing to recommend that the Centers for Medicare and Medicaid Services (CMS) extend the Healthcare.gov open-enrollment period through January 31st or, at a minimum through December 30th, to allow Americans more time to sign up for health care coverage during this pandemic.

via Covered California:

As COVID-19 Pandemic Surges Across the State, Covered California Takes the Unprecedented Step of Giving Consumers Until Dec. 30 to Sign up Up for Coverage that That Begins on Jan. 1

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:

  • I've now completed updating the partisan lean for every county except Alaska (I'm having trouble getting that broken out by "County-Equivalent Region") to the 2020 Biden/Trump results. Alaska still uses the Clinton/Trump 2016 results, although I can't imagine more than one or two regions changed status there this year.
  • I've also added columns listing the actual Biden/Trump vote percentage for each county to give a feel for how partisan it is. Again, I'm defining "Swing District" as any county where the difference is less than 6.0%. There's 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.
  • Finally, new this week: I've added all of the U.S. territories, including a county-equivalent breakout for Puerto Rico, as well as American Samoa, Guam and the U.S. Virgin Islands. None of these vote in the general Presidential election, of course, but I'm still tracking their COVID-19 case & death rates. None show up in the top 100 of either ranking, however.

With these updates in mind, here's the top 100 counties ranked by per capita COVID-19 cases as of Friday, December 11th (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 was doing this earlier in the summer but stopped updating it in August; I've started over with a fresh spreadsheet and have expanded it to include every U.S. territory, including not just DC & Puerto Rico but also American Samoa, Guam, the U.S. Virgin Islands and even the Northern Mariana Islands.

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. 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, which are skyrocketing.

North and South Dakota are the first two states where more than 10% of the entire population has tested positive (in fact, North Dakota is past 11% already. Iowa, Wisconsin, Nebraska and Utah could all potentially hit the 10% milestone by New Year's Eve as well.

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