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.

Important:

  • Every county except those in Alaska lists the 2020 Biden/Trump partisan lean; Alaska still uses the 2016 Clinton/Trump results (the 2020 Alaska results are only available by state legislative district, not by county/borough for some reason...if anyone has that info let me know)
  • I define a "Swing District" as one where the difference between Biden & Trump was less than 6.0%. FWIW, there's just 187 swing districts (out of over 3,100 total), with around 33.7 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 those caveats in mind, here's the top 100 counties ranked by per capita COVID-19 cases as of Thursday, April 8th, 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 (Biden or Trump won by less than 6 points)

Two months ago, I noted that the Washington state legislature had decided to beef up their quasi-Public Option law to make the PO plans (called "Cascade Select") more robust and less expensive:

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":

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.

More than 1 out of every 8 residents of North Dakota, South Dakota and Rhode Island have tested positive for COVID-19 over the past year.

More than 1 out of every 9 residents of Iowa, Utah, Tennessee and Arizona have tested positive.

More than 1 out of 10 in Nebraska, Arkansas, South Carolina, New Jersey, Alabama, Kansas, Indiana, Mississippi, Idaho, New York, Georgia, Illinois, Wisconsin and Delaware.

More than 1 out of 20 in every state & territory EXCEPT Washington, Guam, Oregon, Maine, Vermont, U.S. Virgin Islands, Hawaii, N. Mariana Islands and American Samoa.

A couple of weeks ago, I used the limited COVID Special Enrollment Period (SEP) data I had for HealthCare.Gov from the last two weeks of February, plus some limited SEP data from a handful of state-based ACA exchanges, to extrapolate out a rough estimate of how many new Qualified Health Plan (QHP) selections may have happened nationally.

At the time, I estimated that perhaps 18,500 people were enrolling per day nationally the final two weeks of February, and that IF that pace remained the same throughout the entire month of March, it would amount to upwards of 832,000 new people enrolling by the end of March (666,000 via HealthCare.Gov, plus another 166,000 via the 15 state-based exchanges).

It's important to note that this wasn't a hard estimate--I was pretty sure that the actual enrollment pace would slow down somewhat after the inital surge, at least until expanded subsidies via the American Rescue Plan (ARP) were officially available in most states, which didn't happen until April 1st.

This just in via Connect for Health Colorado:

More Coloradans Than Ever Are Using Colorado’s Exchange to Get Covered

DENVER — In a report released today by Connect for Health Colorado, nearly 180,000 Coloradans signed up for a health insurance plan by the end of the Open Enrollment Period on Jan. 15 for 2021 coverage. The new report includes more detailed information about changes to premium costs and financial help by county, the improved customer experience and our outreach tactics.

The main number here is nothing new; C4HCO had already announced the 180K figure back in January. The report itself contains a ton of key demographic stats & details, however, which I'll get to below.

I last updated my Michigan Medicaid expansion tracking back in January.At the time, I noted that enrollment in this ACA programhas increased dramatically here in Michigan since the COVID-19 pandemic struck, increasing from 673,000 in February 2020 to 853,000 as of January 2021, or nearly 27% in less than one year.

As of April 5th, the Healthy Michigan program (that's the branding of Michigan's ACA Medicaid expansion) notes 897,261 enrollees. That's a net increase of 224,000 Michiganders enrolled in the program since last February, or over 33%.

With this as backdrop, consider the timing of the following events:

The Kaiser Family Foundation has updated their estimated breakout of the entire uninsured population of the United States as of 2019, and what sort of healthcare coverage they're eligible for thanks to the Affordable Care Act and the American Rescue Plan's expanded/enhanced subsidies.

Obviously a lot has changed since then, primarily due to the COVID-19 pandemic, but I presume this is the most recent comprehensive, reliable data they've been able to compile:

Gummy Penis

March 2, 2021:

The ACA's language didn't account for the possibility that some states might not expand Medicaid, which is why the lower-end range of exchange plan subsidy eligibility starts off at 100% FPL...

Unfortunately, those earning less than 100% FPL are still stuck without any viable options besides either "going bare" and praying they don't get sick or injured or possibly buying a junk plan of some sort. According to the Kaiser Family Foundation, there's around 2.2 million Americans still caught in the "Medicaid Gap", where they don't qualify for Medicaid but don't earn enough to be eligible for subsidized ACA exchange policies (Kaiser estimates another 1.8 million uninsured adults in these states in the 100 - 138% "overlap" cateogory, plus around 356,000 who are eligible for Medicaid but still haven't enrolled for one reason or another).

Note: A few weeks ago, I ran a rough back-of-the-envelope extrapolation of partial data from the first 2 weeks of the ongoing COVID Special Enrollment Period and concluded that IF enrollment via the 36 HealthCare.Gov states was representative nationally, and IF the pace of the last 2 weeks of February held perfectly steady, it would mean around 666,000 new enrollees via HC.gov and 832,000 nationally by the end of March. Those were two pretty big caveats, of course, and as you'll see below, the reality wasn't quite as eyebrow-raising, though it's still pretty impressive.

This just in via the Centers for Medicare & Medicaid Services (CMS):

2021 Marketplace Special Enrollment Period Report

February 15 – March 31, 2021

The date on this press release is April 1st, but I didn't see it on the MD Connect website until today:

AMERICAN RESCUE PLAN ACT DRAMATICALLY LOWERS HEALTH CARE COSTS FOR MANY MARYLANDERS

Low income individuals and families will pay nearly nothing for private health plans, higher income will be eligible for savings for the first time

(BALTIMORE) — Gov. Larry Hogan and Maryland Health Connection today announced reductions in the health plan costs that reflect additional financial help available through the federal American Rescue Plan Act. The new law means that:

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