(Note: Most of this is a shortened version of my post from seven weeks ago...with a pretty important update at the end):

Just over a year ago, Bright HealthCare, which was only founded in 2016, announced that they were dramatically expanding their operations around the U.S.:

Bright HealthCare Expands Affordable Plans in 42 New Markets Next Year Including in Texas, Georgia, Utah and Virginia

Back in 2019, long before the American Rescue Plan passed, I embarked on an ambitious project. I wanted to see what the real-world effects would be of passing a piece of legislation which would eliminate the Affordable Care Act's so-called "Subsidy Cliff" while also strengthening the subsidy formula for those who qualified. Call it "ACA 2.0" for short, if you will (that's what I do, anyway).

This legislation has been around in near-identical form under one official title or another for years, usually bundled within a larger healthcare package. In 2018 it was called the "Undo Sabotage & Expand Affordability of Health Insurance Act of 2018" (or "USEAHIA" which is about as awkward a title as I can imagine.

In 2019 it was rebranded as the "Protecting Pre-Existing Conditions and Making Healthcare More Affordable Act" or "PPECMHMAA," which somehow managed to be even more awkward.

Sherman, set the Wayback Machine to 2015:

MICHIGAN: Another One (Mostly) Bites The Dust; 12th CO-OP Drops Off Exchange, May Go Belly-Up

It appears that East Lansing-based Consumers Mutual Insurance of Michigan could wind down operations this year as it is not participating in the state health insurance exchange for 2016.

But officials of Consumers Mutual today are discussing several options that could determine its future status with the state Department of Insurance and Financial Services, said David Eich, marketing and public relations officer with Consumers Mutual.

Consumers Mutual CEO Dennis Litos said: "We are reviewing our situation (financial condition) with DIFS and should conclude on a future direction this week.”

While Eich said he could not disclose the options, he said one is “winding down” the company, which has 28,000 members, including about 6,000 on the exchange.


Virginia has an extremely robust, competitive individual & small group insurance market...and in 2023 it's getting even more competitive, with what appear to be two new carriers joining the individual market (Aetna Health Inc. and Anthem EPO), although Anthem is only offering off-exchange policies (why??) while Bright Health Insurance appears to be dropping out of the individual market (which is a common theme for Bright this year...)

Virginia used to be one of the first states to release their preliminary rate filings for the upcoming year, but for the past year or two it's been among the later ones. I don't know how much of this is due to COVID-related issues or if it's just an internal policy change for some other reason. Regardless, as a result, VA also happens to be the first state to release their annual rate filings since the Inflation Reduction Act (which includes a 3-year extension of the enhanced ACA subsidies) passed both the U.S. House and Senate.

Way back in the Before Times® of 2015, fellow healthcare policy wonk Andrew Sprung (aka Xpostfactoid) posed an interesting question:

Do any ACA marketplace enrollees (or off-exchange enrollees for that matter) actually confess to being smokers? Why would you?

— xpostfactoid (@xpostfactoid1) November 13, 2015


As I noted in a bunch of posts yesterday, several states have launched "Tax Time Special Enrollment Periods" (Maryland launched theirs a couple years ago; Colorado, Massachusetts & Pennsylvania are bringing their programs online right now). New Mexico is also moving their own version through the legislative process.

Well, it turns out (thanks to Louise Norris for the heads up) that Virginia also passed their own version of this bill last year...although in their case it's being phased in over a two year time period:


Virginia has an extremely robust, competitive individual & small group insurance market...and in 2022 it's getting even more competitive, with three new carriers joining the individual market: Aetna, Bright and Innovation Health Plan.

Beyond that, I don't see any shocking or dramatic developments for 2022; average unsubsidized individual market premiums are dropping by 2.9% statewide, while average small group premiums are increasing by 3.6% overall.


I've once again relaunched my project from last fall to track Medicaid enrollment (both standard and expansion alike) on a monthly basis for every state dating back to the ACA being signed into law.

For the various enrollment data, I'm using data from's Medicaid Enrollment Data Collected Through MBES reports. Unfortunately, they've only published enrollment data through December 2020. In most states I've been able to get more recent enrollment data from state websites and other sources.

For Virginia, I'm using adjusted raw data from the Virginia Dept. of Medical Assistance Services.


UPDATE: As I figured, the original data was massivly wrong. Just as one simple example, Virginia's own data set puts Danville's vaccination rate at around 35.5% vs. the 0.1% according to the CDC data.

Someone on Twitter pointed me towards this COVID-19 Community Profile Report which explains the problem:

The following states have ≤80% completeness reporting vaccinations by county, which may result in underestimates of vaccination data for counties and CBSAs: VT (74%), CO (73%), WV (54%), VA (51%), GA (50%), HI (0%), AS (0%), TX (0%), PW (0%), FM (0%), MH (0%), MP (0%)

I'm not doing the U.S. territories anyway, and I gathered the data for Hawaii and Texas straight from the state health departments. Sounds like I'll have to do the same for Virginia if possible. I'll also have to go back and re-do Colorado, Georgia and Vermont, though there was at least some clear pattern in those states (Vermont has few enough counties that it'd be hard to see one anyway). I haven't gotten to West Virginia yet.

I'll leave this post up for the moment but will take it down this evening until I've corrected the data.

UPDATE 6/02/21 9:11pm: OK, I'm using the data from the COVID Act Now project instead, which appears to be pulling their data directly from the Virginia Health Dept's website. Oddly, they don't list any numbers for Manassas City and Manassas Park, so I've pulled it directly from the VA COVID Vaccine Tracker myself.

I've swapped out both the graphs and the county/city table with the corrected versions below.

There still doesn't appear to be much of a partisan lean correlation in Virginia--it's more apparent in the "bubble view" which sizes the dots by population--but at least the numbers are accurate and make sense now, which is the main point.

Now that I've developed a standardized format/layout & methodology for tracking both state- and county-level COVID vaccination levels by partisan lean (which can also be easily applied to other variables like education level, median income, population density, ethnicity, etc), I've started moving beyond my home state of Michigan.

Here's Virginia:

NOTE: The CDC lists ~1.895 million Virginia residents (9.6% of the total fully vaccinated) whose county of residence is unknown. In addition, there are 9 counties which don't list any vaccination data at all. Both of these could skew the trendline significantly.

Even with those factors accounted for, the Virginia graphs below are still massively out of whack with almost every other state. I don't mean because the trendline tilts slightly upwards towards the right side--New Jersey does that as well--I mean because there's massive ranges in vaccination rates across the board regardless of partisan lean, relative county population, etc. Even New Jersey still seems to form some sort of coherent pattern.

I don't know if this is a data error or what. Will update if I find out more.

Gold Bars

NOTE: This is an updated version of a post from a couple of months ago. Since then, there's been a MASSIVELY important development: The passage of the American Rescue Plan, which includes a dramatic upgrade in ACA subsidies for not only the millions of people already receiving them, but for millions more who didn't previously qualify for financial assistance.

Much has been written by myself and others (especially the Kaiser Family Foundation) about the fact that millions of uninsured Americans are eligible for ZERO PREMIUM Bronze ACA healthcare policies.

I say "Zero Premium" instead of "Free" because there's still deductibles and co-pays involved, although all ACA plans also include a long list of free preventative services from physicals and blood screenings to mammograms and immunizations with no deductible or co-pay involved.