This is a HUGE deal, especially in California, where an estimated 430,000 residents are enrolled in off-exchange ACA policies which are virtually identical to their on-exchange equivalent, with the sole distinction of those enrolled in them not being eligible for ACA subsidies.
With subsidies being beefed up and the 400% FPL subsidy cliff having been killed (for the next 2 years, at least), this means that hundreds of thousands of Californians have just become eligible for thousands of dollars in savings...as long as they transition to the same plan on-exchange.
Republican lawmakers blocked Medicaid expansion funding from reaching the Missouri House floor on Wednesday, posing a setback for the voter-approved plan to increase eligibility for the state health care program.
The House Budget Committee voted along party lines not to pass a bill allowing Missouri to spend $130 million of state funds and $1.6 billion in federal money to pay for the program’s expansion. Under the Affordable Care Act, the federal government picks up 90% of the tab on expanding Medicaid.
The expanded eligibility would allow estimated 230,000 additional low-income Missourians to be covered. It is set to go into effect in July after voters approved a ballot question last August with a 53% majority.
The Division of Insurance (“Division”) encourages all Nevadans to take advantage of the new saving opportunities offered by the American Rescue Plan Act of 2021 (“ARPA”). The ARPA, enacted earlier this month, creates more opportunities for Nevadans to save on health insurance coverage.
“I urge consumers, especially those who have off-exchange plans, have no insurance or have found themselves uninsured to start thinking now about how they can benefit from this new law because certain benefits in the ARPA have deadlines,” said Insurance Commissioner Barbara Richardson. “Each month that a consumer does not take advantage of these new low or no cost opportunities, they are leaving money on the table.”
The ARPA will lower monthly premium costs; increase subsidy eligibility for consumers making above the 400% of the Federal Poverty Level; provide options for people who are on unemployment for $0 premium plans; and it will provide 100% COBRA subsidy for six months.
It's been awhile since I've written anything about the ACA's Basic Health Plan (BHP) provision. BHP is a program which every state has the option of taking advantage of, but so far only two have: Minnesota and New York State. I'll let Louise Norris explain:
Under the ACA, most states have expanded Medicaid to people with income up to 138 percent of the poverty level. But people with incomes very close to the Medicaid eligibility cutoff frequently experience changes in income that result in switching from Medicaid to ACA’s qualified health plans (QHPs) and back. This “churning” creates fluctuating healthcare costs and premiums, and increased administrative work for the insureds, the QHP carriers and Medicaid programs.
Pelosi: Drug Pricing May Pay For Health Care Pieces Of Infrastructure Bill
House Speaker Nancy Pelosi (D-CA) said everything is on the table for the next legislative package that is expected to focus on infrastructure improvements and include health care provisions like a permanent increase to the Affordable Care Act tax credits — and she said the package likely will be paid for by tackling prescription drug prices.
...Pelosi said including House Democrats’ drug pricing bill, H.R.3, would pay for $500 billion of the cost of the infrastructure bill, part of which could be used to boost ACA tax credits and make ACA coverage more affordable. The savings also could also be used for other health-related efforts, she said. For example, House Energy & Commerce Chair Frank Pallone (D-NJ) has been working with Rep. Jim Clyburn (D-SC) to expand community health centers and to improve broadband services, which would support telehealth.
Your Health Idaho, which had been scheduled to end their COVID-19 Enrollment Period on March 31st, has understandably extended the deadline out by another month in light of the American Rescue Plan's expanded/enhanced subsidies. Via email:
Enhanced Subsidies Go into Effect at Your Health Idaho April 1
Your Health Idaho Continues to Enroll Idahoans through April 30, 2021
BOISE, Idaho –Your Health Idaho, the state insurance exchange, will remain open throughout the month of April so Idahoans can take advantage of enhanced financial assistance, which lowers consumer’s monthly premiums.
For the first time ever, tax credits, which act like an instant discount, may be available for those who were not previously eligible and will be increased for Idahoans who already receive them. For some Idahoans, these savings can be significant. For example, a Treasure Valley married couple in their 20s making $50,000 a year could pay less than $10 a month and a family of four making $105,000 could pay as little as $200 a month.
I honestly thought that I had written the final chapter in this absurd saga, which started two administrations, two House Speakers, three HHS Secretaries and three U.S. Attorney Generals ago when the Federal Circuit Court issued their final ruling last August, but apparently not.
Since this insanity has been grinding away for nearly seven years now, I'm pretty much just reposting my entire August entry, with an important update tacked on at the end.
Here's a quick recap:
The ACA includes two types of financial subsidies for individual market enrollees through the ACA exchanges (HealthCare.Gov, CoveredCA.com, etc). One program is called Advance Premium Tax Credits (APTC), which reduces monthly premiums for low- and moderate-income. APTCs are the subsidies which have been substantially beefed up by the American Rescue Plan (the additional subsidies will be available starting in April in most states, soon thereafter in most other states).
The other type of subsidies are called Cost Sharing Reductions (CSR), which reduce deductibles, co-pays and other out-of-pocket expenses for low-income enrollees.
In 2014, then-Speaker of the House John Boehner filed a lawsuit on behalf of Congressional Republicans against the Obama Administration. They had several beefs with the ACA (shocker!), including a claim that the CSR payments were unconstitutional because they weren't explicitly appropriated by Congress in the text of the Affordable Care Act (even though the program itself was described in detail, including the payment mechanism/etc.)
In the United States, major medical insurance policies for those who don't have healthcare coverage through their employer, Medicare, Medicaid, CHIP, the Veteran's Administration or some other source are available via the ACA's individual market exchanges. The individual market for residents of 36 states is HealthCare.Gov; the remaining 14 states + DC each have their own ACA exchange, such as Covered California, NY State of Health and so forth.
There are usually dozens of ACA policies available via the ACA exchanges, but they fall into five major categories: Catastrophic, Bronze, Silver, Gold and Platinum plans (other major distinctions include HMOs vs. PPOs and other variables,but those are for another day).
With rare exceptions, Catastrophic plans are only available to enrollees under 30 years old. ACA premium subsidies can't be used to help pay for Catastrophic plans either, so enrollment is rare; during the 2020 Open Enrollment Period, only 89,000 ACA exchange enrollees selected Catastrophic plans out of over 11.4 million total, or just 0.8%.
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, March 18th, 2021 (click image for high-res version).
Blue = Joe Biden won by more than 6 points
Orange = Donald Trumpwon by more than 6 points
Yellow = Swing District (Biden or Trump won by less than 6 points)
Missouri just voted #YesOn2 to expand Medicaid, and now, because of YOUR vote, over 230,000 hardworking people will have access to life-saving healthcare!pic.twitter.com/azHN0GJjEW
— YesOn2: Healthcare for Missouri (@YesOn2MO) August 5, 2020
Last summer, when activists in both Missouri and Oklahoma were preparing for this historic vote, I wrote the following:
How NY State of Health Enrollees Benefit from the American Rescue Plan
The American Rescue Plan, which was signed into law on March 11, 2021, will lower health care costs by providing new and expanded financial assistance to New Yorkers enrolling in health insurance through NY State of Health. This enhanced assistance is available to current enrollees and new enrollees, including to higher-income individuals for the first time. Starting in early April, individuals with low and moderate incomes can access higher tax credits. Starting in June, NY State of Health will apply these higher tax credits to current enrollees without requiring any action by the enrollee. Also in June, higher-income New Yorkers can access the new tax credits.
The information on this page is organized into six sections. Click the section from the following list to learn how the American Rescue Plan can help you:
GOV. HOGAN ANNOUNCES EXTENSION OF STATE HEALTH INSURANCE SPECIAL ENROLLMENT PERIOD UNTIL AUG. 15
(BALTIMORE) — Gov. Larry Hogan and Maryland Health Benefit Exchange announced today that the state health insurance marketplace, Maryland Health Connection, will extend its current Coronavirus Special Enrollment Period. Uninsured Marylanders have the opportunity to enroll in health coverage now until Aug. 15.
This deadline aligns with the federal special enrollment period extension announced by President Joe Biden for those 35 states that use HealthCare.gov, the federally run health insurance marketplace.
“We are pleased to announce the additional extension of this special enrollment period to Aug. 15, which
is already one of the nation’s longest in response to the COVID-19 pandemic,” said Governor Hogan.
“Our administration remains committed to ensuring Marylanders have access to the resources they need
UPDATE 3/16/21:Health Source Rhode Island just released their 2021 OEP report as well; they ended up down around 8% y/y. With that, I now have either the final official enrollment numbers or at least close approximations for all 50 states + DC. The table, graph and text below have been updated accordingly.
With New York State of Health releasing their 2021 Open Enrollment Report data (w/some caveats), I now have official (or semi-official) enrollment data for 49 states and the District of Columbia. The odd man out is Rhode Island...which also happens to be one of the smallest states with the smallest number of ACA enrollments; last year they enrolled around 34,600 people.
There's a few caveats:
New York's QHP tally included enrollments through 2/28; the official CMS report will likely cut them off as of 1/31.
The numbers for DC, Idaho, Rhode Island and Vermont are estimates...it's possible that the official numbers for each will be slightly lower.
At the very worst, the official CMS 2021 OEP report will come in at something like 11.98 million or so.
UPDATE 3/16/21: With Rhode Island added, the semi-official tally comes in at just over 12.0 million (12,005,270 QHP selections total). Again, it could drop slightly below that if my estimates for a handful of states are off, but it should be damned close to it.
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 dwarfed by North & South Dakota, although things are pretty horrible nearly everywhere now.
1 out of every 8 residents of North Dakota, South Dakota and Rhode Island have tested positive for COVID-19 over the past year.
1 out of every 9 residents of Utah, Iowa, Tennessee and Arizona have tested positive.
1 out of 10 in Oklahoma Arkansas, Nebraska, South Carolina, Alabama, Kansas, Mississippi,Indiana and Idaho.
1 out of 20 in every state except Washington, Oregon, Maine, Vermont and Hawaii.
Governor McKee and HealthSource RI Announce New Enrollment Period Extended Through August 15
Historic level of financial assistance is now available through HealthSource RI.
New Enrollment Period has been extended through August 15, 2021, adding three months to the previous May 15, 2021 deadline.
Starting April 1, most HSRI customers will have a lower monthly bill.
Beginning in summer 2021, HSRI will make more financial assistance available to people who previously did not qualify to receive it based on their income.
Individuals and families who have received unemployment payments in 2021 will be newly eligible for additional financial help for this year or may qualify for health coverage at no cost.
Rhode Islanders should enroll in coverage as soon as possible to take full advantage of these new benefits.
A few weeks ago, Pennie (Pennsylvania's ACA exchange), like several other state-based exchanges, put out a simple statement celebrating the passage of the American Rescue Plan (ARP) and the dramatic improvement in ACA affordability that it brings for the next two years. Like most of the other exchanges, Pennie's initial press release was pretty bare-bones, as the bill had just been signed into law and there were a ton of logistical details to be worked out.
Implement ARP provisions as soon as possible, and as broadly as possible, to maximize savings for Pennie customers
Automate these provisions, to the extent possible, to ensure that the benefits under the new law reach Pennie customers without requiring customer action
Ensure that customers who need to take an action are given specific instructions on what they need to do to maximize their benefits
Use this unique opportunity to connect more Pennsylvanians to comprehensive coverage and reduce the number of uninsured throughout the Commonwealth
Last week the Maryland Health Benefit Exchange issued a press release touting impressive enrollment numbers over the past year via their year-long COVID-19 Special Enrollment Period (SEP). The topline number was that they enrolled over 140,000 Maryland residents in either ACA exchange policies or Medicaid.
Since Medicaid enrollment is open year-round anyway, the number I'm obviously more interested in are the exchange plans, which most people can normally only enroll in during the official Open Enrollment Period each fall/winter. Since COVID has thrown that mostly into disarray, however, I've been keeping a close eye on SEP enrollment in 2020 and now in spring of 2021 as compared to the pre-COVID era, when the SEP rules were far more strictly adhered to.
The Kaiser Family Foundation has updated their ACA Exchange Subsidy Calculator tool, which lets you plug in your household information and calculate how much you're eligible for in subsidies, as well as telling you things like:
Your percent of the Federal Poverty Level (FPL)
The full-price benchmark Silver plan
Your net price for the benchmark Silver plan
The net price of theleast-expensive Bronze plan
The maximum you'd have to pay in out-of-pocket costs
It's been updated to reflect the newly-expanded & enhanced subsidies available under the American Rescue Plan for 2021 & 2022. The official ACA exchange websites will have this data available over the next few weeks depending on which state you live in (HealthCare.Gov is supposed to go live on April 1st; Covered California on April 12th; other states will vary):
Connect for Health Colorado Extends Enrollment Period through at least August 15
DENVER — Yesterday afternoon, President Biden announced that the federal health insurance marketplace, HealthCare.gov, will extend the current enrollment period through August 15, 2021, to help as many people as possible get covered following the passage of the American Rescue Plan Act of 2021.
Connect for Heath Colorado® Chief Executive Officer, Kevin Patterson, released the following statement in response:
“We will follow the federal decision so that we can help as many Coloradans as possible get covered this year. Keeping our doors open through at least mid-August maximizes the number of people who can apply for financial help and enroll through our Marketplace, especially as our state recovers from the pandemic. We will share more details soon about how Coloradans who are newly eligible for benefits under the American Rescue Plan can get those additional savings.”
At the time, HealthCare.Gov had reported 206,000 Qualified Health Plan (QHP) selections as of February 28th. I also had some partial COVID SEP data from a handful of the state-based ACA exchanges, as of various dates. I had 225,000 QHPs confirmed nationally.
At the time, I concluded that based on the enrollment pace of the first few weeks...
As noted above, Medicaid expansion states have only increased average SEP enrollment by around 2/3 as much as Non-expansion states. Since all 15 state-based exchanges have expanded Medicaid, this suggests that the 206K via HC.gov probably represents more like 80% of the total, meaning perhaps 258,000 nationally (~168,000 more than average).
A couple of weeks ago I went on a bit of a rant about some terribly irresponsible reporting about how much the American Rescue Plan is spending on subsidizing private health insurance and how many people that money is expected to provide insurance premium assistance for.
The bottom line is that a whole lot of people got both the numerator and denominator wrong: Instead of being ~$53 billion to cover ~1.3 million people (which would be an insane $40,000 per person for just six months), it's actually more like ~$61 billion to help cover ~18.6 million people (roughly $3,300 per person per year on average).
Launching a new special-enrollment period – Covered California will open a new special-enrollment period – which will start on Monday, April 12 and run through the end of the year – to give uninsured and unsubsidized Californians time to sign up for coverage that starts as soon as May 1 and continue the outreach and enrollment effort to have marketing pay-off over time.
Today, President Biden announced that the Centers for Medicare & Medicaid Services (CMS) is extending access to the Special Enrollment Period (SEP) until August 15 – giving consumers additional time to take advantage of new savings through the American Rescue Plan. This action provides new and current enrollees an additional three months to enroll or re-evaluate their coverage needs with increased tax credits available to reduce premiums.
On March 20th, the Vermont Health Connect ACA exchange joined other state-based exchanges in launching a formal COVID-19 Special Enrollment Period.
On April 15th, just ahead of the original SEP deadline, they bumped it out by a month.
Then, with the May deadline approaching, I took a look and sure enough, they've bumped it out another month.
And now, with the June deadline having come and gone...
Due to the COVID-19 emergency, Vermont Health Connect has opened a Special Enrollment Period until August 14, 2020.
I admit that this is starting to get a bit silly. At a certain point I'm guessing at least one of the state exchanges will just say "screw it" and open 2020 enrollment up for the full year.
Massachusetts Health Connector to Provide New, Additional Financial Help for Health Insurance Premiums
Extended enrollment to run through July 23 to maximize opportunity for residents to gain access to new premium support
March 23, 2021 – The Massachusetts Health Connector will be able to provide hundreds of thousands of people with new and increased help paying for their health insurance premiums as a result of the recently enacted American Rescue Plan, starting for May coverage.
The new law will make federal premium subsidies, known as Advance Premium Tax Credits, more generous in two ways: It will increase them for many of the Massachusetts residents who already receive them, and it will make federal premium subsidies available to more people who have never qualified before.
Statement re: 11th Anniversary of the Affordable Care Act
Heather Korbulic, executive director, Silver State Health Insurance Exchange
Tomorrow, March 23, 2021, marks 11 years since the passing of the Affordable Care Act (ACA), the landmark reform law that is credited with increasing access to quality healthcare for millions of Americans, forever changing the national healthcare landscape.
Here in Nevada, the ACA is responsible for the creation and ongoing operations of the Silver State Health Insurance Exchange that has provided healthcare coverage to hundreds of thousands of Nevadans who would otherwise be without coverage to receive essential and critical healthcare services. Since the passage of the ACA and the implementation of Nevada Health Link, the Exchange’s online marketplace for ACA-compliant insurance plans, Nevada's number of uninsured has decreased from a staggering 23 percent to 11 percent.
Washington Health Benefit Exchange Issues Statement on the Signing of the American Rescue Plan Act of 2021
Pam MacEwan, CEO Washington Health Benefit Exchange (Exchange), issued the following statement today following the signing of the American Rescue Plan Act of 2021:
“The new stimulus plan is great news for both our current Exchange customers as well as the uninsured who have not been able to afford health insurance. Enhanced premium assistance will help people afford and keep health coverage during the current pandemic.
“Our enduring goal is to ensure that every Washingtonian can get affordable health insurance coverage for themselves and their family. Today’s landmark legislation takes the necessary steps to help those who face high insurance costs that have prevented them getting health coverage for 2021 and 2022.
This is from a couple of weeks ago; I'm reposting it standalone for clarity. via HealthSource RI:
New Federal Changes Mean An Increase In Financial Help for Most HealthSource RI Customers; New Customers May Also Enroll Now
EAST PROVIDENCE, Rhode Island (March 11, 2021) — Recent changes at the federal level mean most HealthSource RI (HSRI) customers will soon be paying less for their health coverage. This change will result in the federal government providing an additional $30 million dollars in Advanced Premium Tax Credits (APTCs) that will bring premium costs down for HealthSource RI customers.
This is from a couple of weeks ago; I'm reposting it standalone for clarity. via Pennie: (via a text graphic for some reason):
Joint Statement from The Pennsylvania Insurance Dept. & Pennie regarding the American Rescue Plan Act of 2021:
"The American Rescue Plan Act of 2021 will not only provide financial assistance through the forthcoming stimulus checks, but will also provide an estimated $270 million in additional subsidies to current Pennie customers in 2021 alone. Through this law, marketplace premiums will be capped at 8.5% of a household's income, meaning current Pennie customers will see lower monthly premiums and those without coverae or who were previously ineligible will now have access to financial help if they shop at Pennie.com.
In some cases, lower-income enrollees will have their monthly premiums eliminated entirely. Additionally, anyone who was eligible for unemployment income in 2021 will be eligible for coverage thorugh Pennie with a $0 premium for the remainder of the year.
MNsure Statement Regarding Federal Changes to the Affordable Care Act
ST. PAUL, Minn.—On Thursday, March 11, President Biden signed the American Rescue Plan, which includes several key health care provisions to the Affordable Care Act that will expand benefits available to Minnesotans through MNsure. This includes an increase in the amount of tax credits MNsure enrollees receive to help them pay for their premiums and an expansion of tax credits to middle-income Minnesotans who previously fell outside income thresholds for financial help. This increase in benefits means Minnesotans who purchase health insurance through MNsure will be able to find a plan with premiums that cost no more than 8.5% of their household income.
This is from a couple of weeks ago, but I'm reposting it standalone for clarity. Via DC Health Link:
Premium Drop for DC Health Link Coverage Thanks to the American Rescue Plan
$36 million in yearly insurance premium savings for DC residents with DC Health Link coverage; coverage available for as little as $2/month for laid-off residents; 100% of COBRA premium paid for laid-off workers
Washington, DC – Today, the DC Health Benefit Exchange Authority announced major savings for residents in the District of Columbia who purchase private health insurance through DC Health Link, the District’s state-based online health insurance marketplace established under the Affordable Care Act (ACA). Now signed into law by President Biden, the American Rescue Plan reduces premiums for health insurance through DC Health Link, provides health insurance for as little as $2/month to people who lost their jobs, and pays for 100% of COBRA for laid-off workers. We estimate that residents will save about $36 million in premiums.
A lot has transpired regarding the American Rescue Plan Act of 2021*. Our team has been meeting with CMS, other state-based marketplaces, our insurance carriers, and other stakeholders, and is in the process of putting together a strategic plan to implement these changes.
We know some of you might be getting questions from customers/stakeholders in the days to come since the federal exchange (Healthcare.gov) will have a robust national campaign supported by President Biden to help spread the word. Here’s what you should know:
Timelines are/will be different: Healthcare.gov will be implementing the subsidy expansion and a possible Special Enrollment Period at a different time than Access Health CT (AHCT). It may start earlier and may end later than CT (we do not know dates at this time).
I actually posted this a couple of weeks ago, but am reposting it as a standalone entry for clarity. Via Connect for Health Colorado:
American Rescue Plan Makes Health Insurance More Affordable for More Coloradans Shopping through the Exchange
DENVER — Yesterday afternoon, President Biden signed the American Rescue Plan Act of 2021(American Rescue Plan) into law. Connect for Heath Colorado® Chief Executive Officer, Kevin Patterson, released the following statement in response to provisions which strengthen the Affordable Care Act and increase affordability:
“We are thrilled and getting ready to implement the health coverage provisions outlined in this law. This expansion of financial help will provide greater access to savings on the health plans we offer. This means more affordable health insurance for many more Coloradans.”
The American Rescue Plan & Additional Financial Relief
The federal government recently passed a COVID-19 relief bill, the American Rescue Plan Act of 2021, which was signed into law by President Biden on March 11, 2021. The new law will reduce health insurance premiums by providing more financial help to eligible consumers who purchase a plan through Get Covered New Jersey. Get Covered New Jersey is working to implement the changes and update its system to ensure that New Jerseyans receive this relief as soon as possible.
More people than ever will qualify for financial help. If you did not qualify for financial help before because your income was too high, you may qualify under the federal changes. If you already receive financial help, you will likely be eligible for additional premium reductions. These new changes make coverage more affordable at many income levels.
The American Rescue Plan does plenty to make private ACA-compliant health insurance dramatically more affordable for everyone earning more than 100% of the Federal Poverty Level. For those below 100% FPL, however, it takes an indirect approach. As I wrote a few weeks ago:
One possible "solution" would have been to simply remove the lower-bound income cut-off point for ACA exchange subsidy eligibility (that is, to lower the threshold from 100% FPL to 0%)...However, this would create two new problems: First, Medicaid is far more comprehensive than nearly all ACA plans...Secondly, if the lower-end subsidy cut-off were removed, it's almost certain that quite a few states which have already expanded the program would reverse themselves and allow Medicaid expansion to expire, in order to save the 10% portion of the cost that they have to pay.
When the $1.9 trillion American Rescue Plan (ARP) achieved final passage on March 10th, it did so almost exclusively along party lines. I say "almost" because there was a single Democratic House member who voted against it: Representative Jared Golden (ME-02).
I fully understand the tightrope that some swing district Dems have to walk. To his credit, Rep. Golden voted to impeach Donald Trump not once, but twice (though he only voted in favor of one of the 2 articles of impeachment against him the first time around). I certainly don't expect every single Democrat to vote the party line on every single bill.
In the end, the bill passed anyway, if only by a handful of votes; my guess is that he even received Speaker Pelosi's unofficial blessing to vote against it, as long as she knew for sure it would pass regardless.
Sen. Mark Warner's Health Care Improvement Act of 2021 (S.352)
Sen. Michael Bennet & Sen. Tim Kaine's re-introduced "Medicare X" Act (S.386, I believe)
Sen. Jeanne Shaheen's Improving Health Care Affordability Act (S.499)
Of the three, the one which seems most likely to actually have a shot at passing both the House and Senate and being signed into law by President Biden during the 2021 - 2022 legislative session is Sen. Shaheen's S.499, which would:
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, March 18th, 2021 (click image for high-res version).
Blue = Joe Biden won by more than 6 points
Orange = Donald Trumpwon by more than 6 points
Yellow = Swing District (Biden or Trump won by less than 6 points)
Yesterday's press release from Covered California included a TON of important information about how they're handling the massive subsidy upgrade/expansion under the American Rescue Plan, but it left out one other critically important item which was caught by Inside Health Policy reporter Amy Lotven:
Insurers participating in Covered California have agreed to help move their off-exchange individual plan enrollees into the marketplace so they can benefit from the new Affordable Care Act subsidies available under the American Rescue Plan (ARP) and will not reset the deductibles, Covered California Executive Director Peter Lee said Thursday (March 18) in a webinar with reporters and key stakeholders.
...Off-exchange enrollees could get an average $500 premium drop, which means they could save as much as $12,000 under the two-year provision, Lee says. About 430,000 Californians and 1.5 million people nationally who are enrolled off-exchange plans are newly eligible for help, the exchange estimates.
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 dwarfed by North & South Dakota, although things are pretty horrible nearly everywhere now.
1 out of every 8 residents of North Dakota, South Dakota and Rhode Island have tested positive for COVID-19 over the past year.
1 out of every 9 residents of Utah, Iowa, Tennessee, Arizona and Oklahoma have tested positive.
1 out of 10 in Arkansas, Nebraska, South Carolina, Alabama, Kansas, Mississippi and Indiana.
Covered California, Community Leaders and Health Plans Highlight Key American Rescue Plan Provisions and Lay Out a Roadmap to Lower Premiums and Help Millions Get Covered
The Maryland Health Benefit Exchange has issued a new press release which on the surface doesn't seem terribly unusual--it touts an impressive number of Maryland residents having gained healthcare coverage since they first launched their COVID-19 Special Enrollment Period (SEP).
What's unusual about this PR is that it's listing the cumulative number of people who've gained coverage since they launched their first COVID SEP a year ago:
MORE THAN 140,000 COVERED SINCE MARYLAND HEALTH CONNECTION LAUNCHED COVID-19 SPECIAL ENROLLMENT ONE YEAR AGO
236,000 WHO STILL LACK COVERAGE COULD GET IT FOR FREE OR WITH SIGNIFICANT FINANCIAL HELP
(MARCH 17, 2021) BALTIMORE — Yesterday marked one year since the Maryland Health Benefit Exchange launched a Coronavirus Emergency Special Enrollment Period in response to the public health emergency declared by Gov. Larry Hogan.
Sen. Mark Warner's Health Care Improvement Act of 2021 (S.352)
Sen. Michael Bennet & Sen. Tim Kaine's re-introduced "Medicare X" Act (S.386, I believe)
Sen. Jeanne Shaheen's Improving Health Care Affordability Act (S.499)
Of the three, the one which seems most likely to actually have a shot at passing both the House and Senate and being signed into law by President Biden during the 2021 - 2022 legislative session is Sen. Shaheen's S.499, which would:
Everyone who spread this disinformation was getting both the numerator and the denominator wrong. In short, they were claiming that the federal government was going to spend up to $53 billion to provide healthcare coverage to a mere 1.3 million people for as little as a six-month period (which would amount to an insane $80,000 per year apiece if true...which it isn't).
As I explained in painstaking detail, the actual amount being spent per person is more like $3,300 apiece for anywhere from 14.2 million to 18.6 million people depending on whether you're going by the House or Senate CBO score (and the final version of the ARP was the Senate version).
Back in late January, Senator Mark Warner of Virginia announced the introduction of a new-ish bill called the Health Care Improvement Act of 2021. Tell me if any of the major provisions look familiar:
Capping health care costs on the ACA exchanges
Establishing a low-cost public health care option
Authorizing the federal government to negotiate prescription drug prices
Allowing insurers to offer health care coverage across state boundaries
Supporting state-run reinsurance programs
Incentivizing states to expand Medicaid
Expanding Medicaid eligibility for new moms
Simplifying enrollment
Increasing Medicaid funding for states with high levels of unemployment
NOTE: SEE SUMMARY TABLE IN UPDATE ALL THE WAY AT THE END.
I'm doing my best to stop myself from putting my head through a wall this weekend.
You may have seen this viral tweet making the rounds over the past day or so:
The Democrats just spent $52 billion to subsidize COBRA for 1.3 million people until September. That’s $40k per person for less than 6 months of health insurance. Most countries spend about $5-6k per person per year for universal healthcare.
This was posted at 12:22pm on Friday, March 12th, 2021. It's still live as of 11:00am on Sunday the 14th, has over 32,700 Likes and has been retweeted over 7,300 times as of this writing, but in case it's deleted by the time you read this, here's a screen shot:
It's important to note that the following guidelines only apply to residents of the 36 states hosted via HC.gov. The timing, policy and procedures for the new/expanded subsidies for residents of the 15 states which operate their own ACA exchanges may vary.
The short version is that because his income is so low, he normally wouldn't be eligible for ACA subsidies...except because he lives in Maryland, a Medicaid expansion state, he would normally be eligible for Medicaid...except that because he's an immigrant who's been in the United States for less than five years, he isn't eligible for Medicaid...except that, thanks to an obscure provision baked into the Affordable Care Act, he is eligible for ACA subsidies after all!
‘(B) SPECIAL RULE FOR CERTAIN INDIVIDUALS LAWFULLY PRESENT IN THE UNITED STATES.—If—
‘‘(i) a taxpayer has a household income which is not greater than 100 percent of an amount equal to the poverty line for a family of the size involved, and
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, March 11th, 2021 (click image for high-res version).
Blue = Joe Biden won by more than 6 points
Orange = Donald Trumpwon by more than 6 points
Yellow = Swing District (Biden or Trump won by less than 6 points)
My biggest takeaway from the press releases below is that everyone will be made whole (that is, those eligible for additional subsidies or newly-eligible for subsidies at all will receive them in full), but that it may take anywhere from a few weeks to several months for that to happen, so cool your jets.
Covered California Hails the Signing of the American Rescue Plan Which Will Benefit Millions
SACRAMENTO, Calif. — Covered California’s executive director, Peter V. Lee, issued this statement following President Joe Biden’s signing of the American Rescue Plan. The landmark legislation provides new financial help to people who receive their health insurance through Affordable Care Act marketplaces like Covered California. The measure will lower health care costs by providing new and expanded subsidies to more Americans than ever before.
During the early days of the Affordable Care Act (and again during the insane "Repeal/Replace" saga of 2017), one of the dumbest and most disingenuous talking points of Republicans was to attack the ACA for being "too long."
I'm quite serious...many Very Serious Conservatives stroked their beards and wrung their hands over the sheer length of the ACA's legislative text (officially around 2,700 pages, though if you includ the mountain of regulations which are included with any major bill impacting hundreds of millions of people it could theoretically be tracked at 20,000 pages or so).
Over 2,200 Minnesotans have signed up for health coverage through MNsure's special enrollment period so far
Special enrollment runs through May 17
ST. PAUL, Minn.—2,285 Minnesotans have signed up for private health insurance coverage since the start of MNsure's special enrollment period on February 16. This three-month special enrollment period, which runs through Monday, May 17, is available to any Minnesotan who is uninsured or who is not currently enrolled in a qualified health plan through MNsure.
Minnesotans who want coverage to start on April 1 must enroll by 11:59 p.m. on Wednesday, March 31. Plans selected during the month of April will have an effective date of May 1, and plans selected by the May 17 deadline will have an effective date of June 1.
In early February, I posted a deep dive into HR 369, the Health Care Affordability Act, and how it would reduce net ACA premiums by permanently eliminating the income "subsidy eligibility cliff" (#KillTheCliff) and making the underlying subsidy formula more generous for all enrollees (#UpTheSubs).
I'm re-posting an updated, modified version of this analysis for two reasons:
First, because HR 1319, the American Rescue Plan, is about to actually pass and be signed into law, with a slightly different formula from HR 369 embedded within it (if only for two years).
Second, because my earlier analysis also threw in two other subsidy enhancement tables which confused the issue (California's state-based subsidies, and the predecessor to HR 369, both of which are/were less generous)
In this version I'm using the actual Advanced Premium Tax Credit (APTC) table under the American Rescue Plan, and I'm cutting out all references to the other two tables to avoid confusion.
Nearly every state (+DC) has re-opened enrollment on their respective ACA exchanges in response to both the ongoing COVID-19 pandemic and the American Rescue Plan (ARP), which substantially expands and enhances premium subsidies to millions of people!
If you've never enrolled in an ACA healthcare policy before, or if you looked into it years ago but weren't impressed, please give it another shot now. Thanks to the ARP (and some other reasons), it's a whole different ballgame this spring & summer.
Here's 10 important things to understand when you #GetCovered:
In previous years, New York State of Health has typically been pretty good about providing timely Open Enrollment reports, so I was mildly irritated by their total radio silence on the issue throughout the 2021 Open Enrollment Period (OEP).
My suspicion was that, like many other states which have expanded Medicaid, New York likely saw a significant drop in on-exchange Qualified Health Plan (QHP) enrollment this season due to the massive job & income loss caused by the COVID-19 pandemic last year, as people "downshifted" from QHPs over to Medicaid. In addition, New York is one of only two states which has the ACA's Basic Health Program (BHP) in place; BHP (called the Essential Plan in NY), is sandwiched in between QHPs and Medicaid, for residents earning between 138 - 200% FPL.
I just received the following COVID Enrollment Period update from Pennie, Pennsylvania's new state-based ACA exchange. This appears to be part of an official report which they're still working on.
The "Existing" numbers refer to current Pennie enrollees who are taking advantage of the COVID SEP to switch to a different plan mid-year; this is something which usually isn't allowed, even during traditional Special Enrollment Periods (SEPs), but Pennie, along with HealthCare.Gov and many of the other state-based exchanges, are allowing them to do so during this period.
There's an obvious reason for this, too: The impending passage of the American Rescue Plan will mean dramatically improved/expanded subsidies for ACA enrollees, including many who haven't been eligible for them until now. This means millions of Americans who enrolled in Bronze plans because they weren't eligible for subsidies will be able to upgrade to Silver or Gold; it also means many people will become eligible for $0-premium plans who currently aren't, and so on.
If you look at the actual legislative text of the final version of the Patient Protection & Affordable Care Act (PPACA, or simply ACA), the table describing the applicable maximum percentage of income that exchange-based enrollees have to pay for their premiums looks like the table below:
(Notably missing is the lower-bound 100% FPL subsidy eligibility cut-off; there's a separate section of the law which notes the 100% threshold but makes an exception for certain lawfully-present immigrants who earn less than 100% FPL but who aren't eligible for Medicaid for various reasons and are given an exception).
One Month In, More Than 4,000 Coloradans Sign Up During Exchange's Uninsured Enrollment Period
DENVER – 4,683 previously uninsured Coloradans signed up for a 2021 health insurance plan through Colorado’s Exchange between Monday, February 8 and the end of day Friday, March 5. That’s more than 1,000 new medical enrollments each week during the first month of Colorado’s Uninsured Enrollment Period.
That's an average of 180/day over 26 days for Colorado. I don't know exactly how many Special Enrollment Period (SEP) enrollees they had during the same time period in prior years, but I can estimate based on their monthly dashboards:
In the face of the continuing COVID-19 pandemic, President Joe Biden reopened enrollment in the Affordable Care Act’s health insurance exchanges.
For Nevadans, that means the Silver State Health Insurance Exchange is back in business.
The exchange connects Nevadans to health plans compliant with the Affordable Care Act, and it’s the only place consumers can access any federal subsidies.
“As soon as Nevada learned of the news from the federal government, we took immediate action to plan and collaborate with our insurance carriers and the statewide network of 750-plus brokers and navigators to implement a seamless, streamlined process for Nevadans,” said Heather Korbulic, executive director of Silver State Health Insurance Exchange.
Korbulic told KNPR's State of Nevada that there has already been a lot of interest from people around the state.
"We're pretty excited about the uptake that we've already started seeing and we think this is a wonderful opportunity for Nevadans to get connected to Nevada HealthLink," she said.
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 Friday, March 5th, 2021 (click image for high-res version).
Blue = Joe Biden won by more than 6 points
Orange = Donald Trumpwon by more than 6 points
Yellow = Swing District (Biden or Trump won by less than 6 points)
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 dwarfed by North & South Dakota, although things are pretty horrible nearly everywhere now.
1 out of every 8 residents of North Dakota, South Dakota and Rhode Island have tested positive for COVID-19 over the past year.
1 out of every 9 residents of Utah, Iowa, Tennessee, Arizona and Oklahoma have tested positive.
1 out of 10 in Arkansas, Nebraska, Kansas, Alabama and South Carolina.
Access Health CT To Host Two Educational “Healthy Chats” During Special Enrollment Period
Free Virtual Sessions to Help Uninsured Connecticut Residents Get Covered
HARTFORD, Conn. (March 4, 2021) — Access Health CT (AHCT) announced today it will host two educational sessions called “Healthy Chats” on Tuesday, March 9 at 6:00 p.m. and Wednesday, March 10 at 6:00 p.m. (Spanish only) to help Connecticut residents learn about plan options, financial help, low-cost and free coverage and tips to stay covered during the Special Enrollment Period that runs until March 15, 2021*. The Special Enrollment Period is for consumers who are not currently enrolled in coverage through AHCT.
About these Healthy Chats
The Healthy Chat events are free and will be held virtually via Zoom (in English & Spanish). To join, attendees can access the event here, or here.
But actually, he thought as he re-adjusted the Ministry of Plenty’s figures, it was not even forgery. It was merely the substitution of one piece of nonsense for another. Most of the material that you were dealing with had no connexion with anything in the real world, not even the kind of connexion that is contained in a direct lie. Statistics were just as much a fantasy in their original version as in their rectified version. A great deal of the time you were expected to make them up out of your head.
Back in late January, when it became clear that the Biden Administration was planning on announcing some sort of "no excuse needed" COVID Special Enrollment Period for the federal ACA exchange, I did a little back-of-the-envelope math to try and get an idea of how many additional people might enroll via HealthCare.Gov than you'd normally see via "standard" Special Enrollment Periods.
At the time, I concluded that for a 60-day SEP of this nature (that is, one completely open to all comers regardless of whether they had a Qualifying Life Experience (QLE)or not), you might be looking at perhaps an extra 400,000 people. selecting plans during that time period. This would be on top of the 4,200/day who enrolled thru HC.gov between the end of Open Enrollment and the end of May via SEPs over the past couple of years, which would be roughly 254,000 for a 60-day period.
March 02, 2021 - In a nationwide case, two individuals have been found guilty of an Affordable Care Act enrollment fraud scheme that used individuals in need of substance abuse care and falsely enrolled them in Affordable Care Act plans, the Department of Justice (DOJ) announced.
The defendants, Jeffrey White and Nicholas White who are father and son respectively, sought to enroll individuals in Affordable Care Act plans in states other than their own, specifically states that had high reimbursement rates for substance abuse treatment.
The two men went so far as to create fake residential addresses and cell phone numbers with accurate area codes that would direct the call to the Whites’ phones.
I'm a couple of weeks behind on this (the full #AmRescuePlan, #HR1319, already passed the House late last Friday night), but Medicaid expansion is one of the core issues I cover here, so it didn't feel right not to give this a write-up.
Before the Affordable Care Act was passed, only certain populations were eligible for Medicaid. Low-income children, pregnant women, parents of minor children and those with certain disabilities and so forth were eligible up to a certain household income threshold ranging from as a ceiling of as little as 13% of the Federal Poverty Line (parents in Alabama) to as much as 375% FPL (pregnant women and newborn infants in, interestingly, Iowa).
Uninsured Special Enrollment Period in Idaho Begins March 1
Idahoans who enroll will have coverage beginning April 1, 2021
BOISE, Idaho – Your Health Idaho, the state insurance exchange, reopens today for Idahoans still seeking 2021 health insurance. Between March 1, and March 31, 2021, uninsured Idahoans can enroll in comprehensive health insurance coverage through the Uninsured Special Enrollment Period.
This Special Enrollment Period is available for any uninsured Idahoan who missed the open enrollment window and is still seeking health insurance for 2021. Idahoans who enroll by the March 31, deadline will have coverage beginning April 1, 2021.
