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, Tennessee, Rhode Island and Iowa are on the verge of passing 1 out of every 10 residents.

34 states have seen at least 1 out of every 15 residents test positive.

via Get Covered NJ:

As Open Enrollment Deadline Nears, Residents Urged to Sign Up for Health Insurance at Get Covered New Jersey

  • ​8 in 10 Qualify For Financial Help to Lower Costs

TRENTON – As the Open Enrollment deadline nears, Governor Phil Murphy, Department of Banking and Insurance Commissioner Marlene Caride, and state legislators today urged residents in need of health insurance for 2021 to sign up for a plan at Get Covered New Jersey.

Open enrollment for the state’s official health insurance marketplace, Get Covered New Jersey ends January 31, 2021. Commissioner Caride reminded New Jerseyans that open enrollment is the only time during the year when residents can enroll in coverage, unless they have a major life event that qualifies them for a Special Enrollment Period or they qualify for NJ FamilyCare. With nearly two weeks left in open enrollment, now is the time to visit Get Covered New Jersey to shop for quality, affordable health insurance and to enroll in a plan by the January 31, 2021 deadline.

via the Washington Health Benefit Exchange:

2021 Open Enrollment for Health Coverage Ends This Friday

  • Act before midnight, Jan. 15, to secure health insurance for this year

Washington Healthplanfinder is alerting all Washingtonians still seeking health insurance that they have until midnight, Jan. 15, to select a health and dental plan for the upcoming 2021 plan year. Coverage for those who enroll before the deadline will start Feb. 1.

“This is the last call for any individuals and families who have not signed up for a health and dental plan,” said Chief Executive Officer Pam MacEwan. “With only a few hours remaining before the deadline, people that still need 2021 coverage should sign up before it is too late.”

via Your Health Idaho:

More than 79,000 Idahoans Enroll in 2021 Health Insurance Coverage

BOISE, Idaho – More than 79,000 Idahoans signed up for 2021 health insurance coverage through the state health insurance exchange, Your Health Idaho, during the annual open enrollment period.

Compared to the same time last year, enrollments on the exchange are down by approximately 10,000. This decline is attributed in large part to the ongoing impacts of the COVID-19 pandemic and resulting public health emergencies and protected coverage policies.  

Last year's official Idaho Open Enrollment Period (OEP) Qualified Health Plan (QHP) total was 78,431, so 79,000 should be slightly higher, not 10,000 lower. What's going on here?

As I noted a year and a half ago in my analysis of Joe Biden's healthcare policy proposal, two major chunks of his plan are taken straight out of the House Democrats ACA 2.0 bills from 2018 & 2019 and from the Elizabeth Warren's ACA 2.0 bill in the Senate (CHIP, or the Consumer Health Insurance Protection Act). In fact, these two particular proposals were even part of Hillary Clinton's 2016 health plan, and originated way back in 2015 under a proposal by the Urban Institute:

Regular readers (and some non-regular readers) may recall that in the week between Christmas and New Year's Eve, I put out an urgent "call to action" request for people to submit Public Comment on the proposed annual Notice of Benefit & Payment Parameters for 2022 (NBPP) rule.

As I explained, every year, the Centers for Medicare & Medicaid (CMS) puts together a bunch of proposed modifications to the implementation details of the ACA. Some are simple clarifications of existing procedures; some are minor tweaks; and some are major changes. Of the major changes, some are positive...and some are negative. In the case of the 2022 NBPP, there are examples of all three...and the major changes are really major. As in, ranging from harmful to likely flat-out illegal.

For 2022, there were several NBPP items which seem either innocuous or are actually good ideas...but there are a couple of pretty questionable ones and a few more which would be outright devastating (there are also a few involving things like Risk Adjustment which I'm not familiar enough with to comment on one way or the other).

via MNsure:

ST. PAUL, Minn.—The Minnesota Insulin Safety Net Program was created to help Minnesotans who face difficulty affording their insulin. The program is made up of two parts: the urgent need program and the continuing need program.

  • The urgent need program—eligible Minnesotans can receive a 30-day supply of insulin immediately at their pharmacy for no more than $35.
  • The The continuing need program—eligible Minnesotans can receive up to a year supply of insulin for no more than $50 per 90-day refill.

To be eligible for the urgent need program, you must—

Less than one year ago, in February 2020, I wrote a lengthy post about a great idea that New Mexico was attempting to put through which, had it succeeded, would have generated up to $125 million per year to be used primarily for reducing individual market premiums:

New Mexico would raise a state health-insurance tax and dedicate the new revenue to programs intended to make health care more affordable under a proposal that passed the state House on Sunday.

Rep. Deborah Armstrong, D-Albuquerque, described the legislation as an unusual opportunity to generate more revenue for health care without increasing the total amount consumers now pay.

The increased state tax would partially replace a federal tax that’s being repealed, she said, meaning health insurance carriers would actually be charged less in taxes than they are now, even after the state increase.

The legislation, House Bill 278, would raise about $125 million in annual revenue when fully phased in — the bulk of it dedicated to a new fund for health care affordability, according to legislative analysts.

Way back on November 30th (a lifetime ago!), my contact at the Massachusetts Health Connector gave me an unofficial mid-period 2021 enrollment report:

Here's where we are at, currently:

  • January effectuations: 275,003
  • Feb. and March effectuations: 5
  • Plan Selections: 9,143
  • Total enrollments: 284,151

As a reminder, "effectuations" have paid the first month premium and are good to go. Plan selections still need payment to start.

As I noted at the time, MA is one of just two states (the other is Rhode Island) which handles premium payments internally, which means they can easily track not just how many people have enrolled but how many have actually made their payments.

Yesterday I requested and received an update six weeks later, and was surprised to see the total number drop slightly:

via DC Health Link:

Hispanic leaders to discuss the vulnerability of Hispanic communities to COVID-19 and state of enrollment opportunities at 6th Annual Hispanic Leadership Health Forum; Virtual enrollment and outreach events scheduled throughout the week

WHAT: 
Despite national studies showing the Hispanic community saw the biggest drops in uninsured rates thanks to the Affordable Care Act (ACA), the uninsured rate for the Hispanic community continues to be significantly higher than in other minority communities, according to a recent United States Census report.

In celebration of the National Hispanic Enrollment Week of Action, DC Health Link—in partnership with the Mayor’s Office of Latino Affairs (MOLA), Greater Washington Hispanic Chamber of Commerce (GWHCC), Mary’s Center and other community based organizations—will host its Annual Hispanic Enrollment Week of Action. DC Health Link is using this Enrollment Week of Action to accelerate outreach efforts to promote, educate and motivate Hispanics to enroll in quality, affordable health insurance. The Hispanic Enrollment Week of Action runs from January 12, 2021 through January 16, 2020.

via the Nevada Health Link:

COVID-19 treatment, diagnosis and vaccines included in all Nevada Health Link plans

  • Open Enrollment ends at 11:59 p.m. Jan. 15, 2021 – three more days remaining

(CARSON CITY, NV) – With only three days remaining in Open Enrollment for 2021 health coverage, Nevada Health Link, the online health insurance marketplace operated by the state agency, the Silver State Health Insurance Exchange (Exchange), reminds Nevadans that all plans include access to COVID-19 related diagnosis and treatment, including COVID-19 vaccines when they become available.

via the Washington Health Benefit Exchange:

Last Days before Washington Healthplanfinder Open Enrollment Deadline

With the Jan. 15 deadline looming, Washingtonians still seeking 2021 health coverage must act now to select a plan on Washington Healthplanfinder. Customers have less than three days to shop for coverage that begins Feb. 1.

Traffic on Washington Healthplanfinder continues to be brisk this week as customers rush ahead of Friday’s deadline. So far, over 218,000 Washingtonians have signed up for 2021 coverage, including more than 40,000 new customers.

“The surge of enrollees securing health and dental coverage has been steady and shows the impact that the pandemic has had on our state,” said Chief Executive Officer Pam MacEwan. “There is limited time left for those who still haven’t enrolled in coverage and I encourage them to review their options on Washington Healthplanfinder.”

Back on December 19th, my colleagues Colin Baillio and Andrew Sprung picked up on something I had posted in response to the semi-final 2021 Open Enrollment snapshot report:

STATE LEVEL:
--25 out of 36 states outperformed last year
--Best % increase y/y: TEXAS (+14.9%)
--Worst $ decrease y/y: KENTUCKY (-6.7%)

I have no idea if there's anything special in either state which caused either to do as well/poorly as they did relative to last year.

Sprung decided to look into it further. He broke out the states between Medicaid expansion and non-expansion states, and voila:

From the state totals one obvious pattern leaps out: enrollment is up 9.7% in states that have not enacted the ACA Medicaid expansion -- and down 0.5% in states that have expanded the expansion (including Nebraska, which opened the Medicaid expansion doors in October of this year).

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

Final Snapshot, November 1 - December 21, 2020

Approximately 8.3 million people selected or were automatically re-enrolled in plans using the HealthCare.gov platform during the 2021 Open Enrollment period.

These snapshots provide point-in-time estimates of weekly plan selections, call center activity and visits to HealthCare.gov or CuidadoDeSalud.gov. The final snapshot reports new plan selections, active plan renewals and automatic renewals. It does not report the number of consumers who paid premiums to effectuate their enrollment.

As a reminder, New Jersey and Pennsylvania transitioned to their own State-based Exchange platforms for 2021, thus they are not on the HealthCare.gov platform for 2021 coverage. Those two states accounted for 578,251 plan selections or 7% of all plan selections during the 2020 Open Enrollment Period. Plan selections for 2021 coverage in these two states will not appear in our figures until we announce the State-based Exchange plan selections.

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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