NOTE: The original version of this post included a serious, bone-headed data error on my part, requiring me to pull the post and revamp it just minutes after it went live. After the main post I'll explain how I screwed up and how I've resolved the issue. The bottom line is that my premise may still be correct, but if so it won't be nearly as dramatically as I had originally thought.
Generally speaking, however, it sure sounds to me like someone in the GOP now believes that their 6-month anti-vaxx propaganda campaign is starting to kill off their own voter base, because everyone from Sean Hannity to Florida Governor Ron "Don't Fauci my Florida" DeSantis seem to have finally gotten the memo.
Today I'm looking at county-level U.S. vaccination rates via two other factors: Income and Education.
For Income, I'm using the USDA Economic Research Service's estimate of Median Household Income from 2019 (which was, of course, the last year before COVID-19 hit the U.S. in the first place).
The lowest countywide median household income in 2019 was around $25,000/year (Clay County, Georgia); the highest was roughly $152,000/year (Loudoun County, Virginia):
One of the biggest criticisms I've received with my county-level vaccination level project is that I haven't taken into account a rather obvious truth about the partisan divide in America: Democrats tend to cluster in much more densely-populated urban areas while Republicans tend to live in more sparsely-populated rural areas.
In addition, regardless of your political lean, you might expect it to be a lot more difficult to get vaccinated if you live out in the middle of the boonies where the nearest hospital, clinic or pharmacy is 50 miles away or whatever...not to mention that if you're the only one for miles around, you might be less likely to see getting vaccinated as a high-priority task regardless of your ideology.
Therefore, the reasoning goes, instead of looking at the partisan lean of each county, it would make much more sense to see how much correlation there is based on population density or whether it's a more urban or rural region, right?
I was planning on only updating the county-level vaccination graph monthly, but given the attention this has received via high-profile folks like David Frum and Paul Krugman, I've decided to post updates weekly.
Every year, I spend months tracking every insurance carrier rate filing for the following year to determine just how much average insurance policy premiums on the individual market are projected to increase or decrease.
Carriers tendency to jump in and out of the market, repeatedly revise their requests, and the confusing blizzard of actual filing forms sometimes make it next to impossible to find the specific data I need. The actual data I need to compile my estimates are actually fairly simple, however. I really only need three pieces of information for each carrier:
How many effectuated enrollees they have enrolled in ACA-compliant individual market policies;
What their average projected premium rate change is for those enrollees (assuming 100% of them renew their existing policies, of course); and
Ideally, a breakout of the reasons behind those rate changes, since there's usually more than one.
Usually I begin this process in late April or early May, but this year I've been swamped with other spring/summer projects: My state-by-state Medicaid Enrollment project and my state/county-level COVID-19 vaccination rate project.
Every year, I spend months tracking every insurance carrier rate filing for the following year to determine just how much average insurance policy premiums on the individual market are projected to increase or decrease.
Carriers tendency to jump in and out of the market, repeatedly revise their requests, and the confusing blizzard of actual filing forms sometimes make it next to impossible to find the specific data I need. The actual data I need to compile my estimates are actually fairly simple, however. I really only need three pieces of information for each carrier:
How many effectuated enrollees they have enrolled in ACA-compliant individual market policies;
What their average projected premium rate change is for those enrollees (assuming 100% of them renew their existing policies, of course); and
Ideally, a breakout of the reasons behind those rate changes, since there's usually more than one.
Usually I begin this process in late April or early May, but this year I've been swamped with other spring/summer projects: My state-by-state Medicaid Enrollment project and my state/county-level COVID-19 vaccination rate project.
HHS Encourages States to Educate Eligible Immigrants about Medicaid Coverage
Today, the US Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS) issued an informational bulletin to states’ Medicaid and Children’s Health Insurance Program (CHIP) agencies reaffirming that the 2019 Public Charge Final Rule – “Inadmissibility on Public Charge Grounds” – is no longer in effect and states should encourage their eligible immigrant populations to access public benefits related to health and housing.
Let's be clear: There's a good ~48 million or so children under age 12 who haven't been approved to take the COVID-19 vaccine yet, roughly 14% of the population. There's also perhaps 8 - 9 million Americans age 12+ who are immunocompromised or have serious allergic reactions to vaccinations, meaning the vaccine would have no effect on them or they can't take it at all. Combined, that's around 17% of the total U.S. population who can't get vaccinated, leaving it up to the other 83% of us who can to do so.
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
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.
At the time, I sliced all 3,100+ counties across all 50 states + DC into 9 regions based on a 3x3 grid:
Vaccination rates: Under 40%, 40-60%, over 60%
Trump 2020 vote: Under 40%, 40-60%, over 60%
I then dug deeper into two of these: Low-Trump/Low-Vaxx counties and High-Trump/High-Vaxx counties.
I found 77 counties in the first category...the population in 62 of which is more than 40% Black (and another 7 are majority Native American).
At the opposite corner, there were only 4 counties...one of which includes The Villages, the massive, MAGA retirement community. I didn't have much insight into the other 3.
I was planning on only updating the county-level vaccination graph monthly, but given the attention this has received via high-profile folks like David Frum and Paul Krugman, I've decided to post updates weekly.
Press Release: NY State of Health Enrollment Continues to Climb, More New Yorkers than Ever Benefitting from Affordable Health Coverage; New Yorkers Save Money on Health Coverage with American Rescue Plan Enhanced Tax Credits
Did You have Unemployment Income in 2021? You may Qualify for Health Insurance with a $0/Month Premium
July 20, 2021
ST. PAUL, Minn.—Minnesotans who received unemployment income at any time in 2021 now can access extremely low-cost health insurance through MNsure.
The new benefits were implemented as part of the American Rescue Plan legislation enacted earlier this year. New federal subsidies for private health insurance on MNsure act as an instant discount for consumers, lowering the cost for monthly premiums. Some Minnesotans can find a plan with a premium as low as $0 per month.
Every year, I spend months tracking every insurance carrier rate filing for the following year to determine just how much average insurance policy premiums on the individual market are projected to increase or decrease.
Carriers tendency to jump in and out of the market, repeatedly revise their requests, and the confusing blizzard of actual filing forms sometimes make it next to impossible to find the specific data I need. The actual data I need to compile my estimates are actually fairly simple, however. I really only need three pieces of information for each carrier:
How many effectuated enrollees they have enrolled in ACA-compliant individual market policies;
What their average projected premium rate change is for those enrollees (assuming 100% of them renew their existing policies, of course); and
Ideally, a breakout of the reasons behind those rate changes, since there's usually more than one.
Usually I begin this process in late April or early May, but this year I've been swamped with other spring/summer projects: My state-by-state Medicaid Enrollment project and my state/county-level COVID-19 vaccination rate project.
For nearly a year, I posted a weekly analysis of the 100 U.S. counties (out of over 3,100 total) which had the highest cumulative rates of COVID-19 cases and deaths per capita. In addition, I also included a running graph which compared the ratio of COVID cases & deaths per capita between blue and red counties to track how this changed over time.
The results were extremely telling: In the early days of the pandemic back in March/April 2020, the blue counties were devastated for a variety of reasons, including heavy population density, the fact they were mostly located along the coasts (usually in cities with major international ports/airport hubs), and so forth. Democrats tend to live in heavily-populated urban areas, while Republicans are prone to live in more sparsely-populated rural areas, so this made sense.
For the first few months, both case and death rates were running as much as 4-5x higher in counties which voted solidly for Hillary Clinton in 2016/Joe Biden in 2020 than in those which voted for Trump in either 2016 or 2020.
CMS Thursday (July 15) announced a new advertising campaign that will run in the final 30 days of the special enrollment period slated to end Aug. 15, and the agency also confirmed Inside Health Policy’sreport that the agency plans to auto-adjust tax credits for consumers who do not return to the federal marketplace starting Sept. 1.
I'm finally pulling myself out of my self-imposed COVID Vaccination Graphing project, and this seems like a good place to start: Earlier today, the House Energy & Commerce Committee held markup hearings for not one, not two, but nineteen different healthcare-related bills...some major, some minor, but all of them are kind of interesting. I don't really know much about any of these so I'm just posting the initial description of most of them, though in a few cases which catch my eye I'll go a bit more in depth:
H.R. 4369, the "National Centers of Excellence in Continuous Pharmaceutical Manufacturing Act"
To amend the 21st Century Cures Act to provide for designation of institutions of higher education that provide research, data, and leadership on continuous manufacturing as National Centers of Excellence in Continuous Pharmaceutical Manufacturing, and for other purposes.
The Access Health CT American Rescue Plan Act Special Enrollment Period has saved Connecticut residents more than $4.5 million in health insurance costs since May 1
Connecticut residents have one month left to enroll.
More than 33,000 enrollees have received new financial help, saving approximately $4.5 million dollars in total.
The American Rescue Plan Act (ARPA) made health insurance coverage more affordable for many Connecticut residents by virtually eliminating or vastly reducing monthly payments (premiums) for people with low and moderate incomes.
HARTFORD, Conn. (July 15, 2021) — Access Health CT (AHCT), Connecticut’s official health insurance marketplace, is reminding Connecticut residents they have one month left to enroll in health insurance coverage during the American Rescue Plan Act Special Enrollment Period ending August 15.
Washington, DC –The DC Health Benefit Exchange Authority (DCHBX) Executive Board voted to adopt recommendations from its Social Justice and Health Disparities Working Group, in an effort to stop racism in health care. These recommendations are focused on three crucial areas in order to establish practices, structures, and policies that can be implemented by DCHBX and DC Health Link health plans to (1) expand access to providers and health systems for communities of color, (2) eliminate health outcome disparities for communities of color, and (3) ensure equitable treatment for patients of color in health care settings and in the delivery of health care services. There are 100,000 people and more than 5,200 employers with private health insurance coverage through DC Health Link. DCHBX is responsible for DC Health Link – the Affordable Care Act on-line health insurance marketplace in DC. The recommendations are for coverage through DC Health Link. However, several recommendations will also benefit residents not covered through DC Health Link.
As I (and others) have written many times, closing the so-called "Medicaid Gap" is one of the trickiest challenges President Biden and Congressional Democrats face when it comes to strengthening and improving the Affordable Care Act.
Once again: Under the ACA, all Americans earning up to 138% of the Federal Poverty Level (FPL)... roughly $17,700/year for a single adult or around $36,500 for a family of four...were supposed to be eligible to join Medicaid regardless of their health status, whether they had kids and so forth.
This was supposed to be the case in all 50 states and the District of Columbia (I'm not sure about Puerto Rico or the other U.S. territories...many ACA provisions never applied to them in the first place).
Unfortunately, one of the major consequences of the NFIB vs. Sebelius Supreme Court Case in 2012 was that expansion of the Medicaid program has to be voluntary on the part of each state.
Tennessee fires top vaccine official as COVID-19 shows signs of new spread
The Tennessee state government on Monday fired its top vaccination official, becoming the latest of about two dozen states to lose years of institutional knowledge about vaccines in the midst of the coronavirus pandemic.
The termination comes as the virus shows new signs of spread in Tennessee, and the more-transmissible delta variant surfaces in greater numbers.
Dr. Michelle Fiscus, the medical director for vaccine-preventable diseases and immunization programs at the Tennessee Department of Health, said she was fired on Monday afternoon and provided a copy of her termination letter. It provides no explanation for her termination.
I didn't make any specific projection for the end of June as I've been swamped with my COVID vaccination tracking project, though I generally expected the enrollment pace to drop off significantly (anyone enrolling in June didn't have their policy kick in until July 1st, meaning their deductible & out-of-pocket cap would be the same even though they're only getting 6 months to use them up). Several hundred thousand more was a reasonable assumption, which would probably bring the national total up to somewhere in the 2 million range.
ST. PAUL, Minn.—Health insurance helps individuals and families prepare for life’s unexpected challenges. To enable more Minnesotans to gain the security of health insurance during the COVID-19 pandemic, MNsure has offered a five-month special enrollment period (SEP) that closes this Friday, July 16, 2021.
If you’re uninsured or are currently enrolled in a health plan outside of MNsure, the COVID-19 SEP is a unique opportunity for you to find affordable, comprehensive health care coverage for 2021 through MNsure. The next open enrollment window won’t be until November 2021, with coverage beginning in January 2022—so don’t wait!
For the updated graph below, I've made a few more tweaks to both my data sources and the graph itself, neither of which makes that much of a difference in terms of impact on the final results:
A few weeks ago, after the Centers for Medicare & Medicaid (CMS) confirmed over 80 million Americans were enrolled in Medicaid or the CHIP program as of January 2021, I posted an analysis which looked at state Medicaid enrollment data beyond January.
While the "thru dates" vary from as early as February to as recent as June, my overall conclusion was that actual total Medicaid/CHIP enrollment as of last month has continued to grow, and now likely stands at more like 88 million. It's even conceivable that it's broken the 90 million threshold as of July.
As I noted:
Since then, the combination of sudden, massive unemployment combined with the Families First & CARES COVID Relief acts (which boost federal funding of Medicaid programs while also prohibiting states from disenrolling current Medicaid enrollees during the public health crisis) have resulted in overall Medicaid enrollment rising dramatically over the past year and a half.
This morning, President Biden signed an executive order entitled "Promoting Competition in the American Economy" which hopes to promote competition across major sectors of the U.S. economy. There's 72 initiatives across a dozen agencies total impacting a wide range of industries; naturally this includes healthcare policy and the HHS Dept.
In the healthcare field, there are four areas addressed by Biden's XO: Prescription drugs, hearing aids, hospital consolidation and the ACA exchange marketplaces:
Prescription Drugs: Americans pay more than 2.5 times as much for the same prescription drugs as peer countries, and sometimes much more. Price increases continue to far surpass inflation. As a result, nearly one in four Americans report difficulties paying for medication, and nearly one in three Americans report not taking their medications as prescribed.
Colorado's Health Insurance Marketplace Maintains Enrollment Momentum
There's still time to enroll
DENVER – As of Wednesday, July 7, 205,813 Coloradans have signed up for a plan that provides coverage this year through Connect for Health Colorado. That’s an additional 5,000 enrollments since last month when Connect for Health Colorado announced its Marketplace had reached a historic enrollment milestone for the 2021 plan year.
That's actually 5,694 more enrollees since June 7th, although they may be knocking it down a bit to account for attrition/etc. That amounts to 190 additional enrollees per day, which is actually up from the ~167/day which Colorado had been averaging from May through June. Huh.
For nearly a year, I posted a weekly analysis of the 100 U.S. counties (out of over 3,100 total) which had the highest cumulative rates of COVID-19 cases and deaths per capita. In addition, I also included a running graph which compared the ratio of COVID cases & deaths per capita between blue and red counties to track how this changed over time.
The results were extremely telling: In the early days of the pandemic back in March/April 2020, the blue counties were devastated for a variety of reasons, including heavy population density, the fact they were mostly located along the coasts (usually in cities with major international ports/airport hubs), and so forth. Democrats tend to live in heavily-populated urban areas, while Republicans are prone to live in more sparsely-populated rural areas, so this made sense.
For the first few months, both case and death rates were running as much as 4-5x higher in counties which voted solidly for Hillary Clinton in 2016/Joe Biden in 2020 than in those which voted for Trump in either 2016 or 2020.
Surprise bills happen when an out-of-network provider is unexpectedly involved in a patient’s care. Patients go to a hospital that accepts their insurance, for example, but get treated there by an emergency room physician who doesn’t. Such doctors often bill those patients for large fees, far higher than what health plans typically pay.
As I've been noting for months (and as the mainstream press has finally started picking up on), while there are several factors explaining why so many people haven't gotten vaccinated yet, the single biggest determining factor is their political lean and, even more specifically, who they voted for President last fall.
However, the impact of partisan lean varies widely from state to state. In some states the regression line is a steep partisan slope, in others the slope is barely there at all. In some states the R-squared (R^2) figure, which helps determine correlation of the partisan lean variable, is high (above 0.7) while in others it's below 0.1.
As I've been noting for months (and as the mainstream press has finally started picking up on), while there are several factors explaining why so many people haven't gotten vaccinated yet, the single biggest determining factor is their political lean and, even more specifically, who they voted for President last fall.
However, there are some outliers, as you would expect when you're looking at a nation of over 330 million people.
According to the latest data, if you take the original "every county" graph...
It's been over a month since I last ran a scatter plot displaying current COVID-19 vaccination rates across every COUNTY nationwide according to the 2020 election results...all 3,100+ of them. With today being the 4th of July, which also happens to be the target date for President Biden's call for at least 70% of all U.S. adults to have received their first vaccination shot.
Oklahoma's Medicaid Expansion will Provide Access to Coverage for 190,000 Oklahomans
Nearly 120,000 People Will Begin Receiving Full Medicaid Benefits on July 1
The Centers for Medicare & Medicaid Services (CMS) announced today that approximately 190,000 individuals between the ages of 19-64 in Oklahoma are now eligible for health coverage, thanks to Medicaid expansion made possible by the Affordable Care Act (ACA). On June 1, 2021, the state began accepting applications, and to date, over 120,000 people have applied for and were determined eligible to receive coverage. On July 1, these individuals will receive full Medicaid benefits, including access to primary and preventive care, emergency, substance abuse, and prescription drug benefits. Thanks to the American Rescue Plan (ARP), Oklahoma is eligible to receive additional federal funding for their Medicaid program, estimated to be nearly $500 million over two years. It is estimated that an additional 70,000 people in Oklahoma who have not yet applied are now eligible for coverage under Medicaid.
With the pace of Americans getting vaccinated slowing down to the point that we're not gonna quite meet President Biden's 4th of July target nationally (70% of adults receiving their first COVID-19 vaccination shot), there's a whole lot of hand-wringing about how much of the problem is access (i.e., people not being able to get time off of work, not having transportation to the clinic to get the shot, etc), how much of it is hesitancy (concerns about safety/efficacy, etc), and how much of it is about...well, to put it gently, being a lost or damaged soul.
Well, a new poll conducted by YouGov for Yahoo News may help answer that question (h/t Richard Skinner for the heads up). The poll, of nearly 1,600 U.S. adults, was conducted from June 22 - 24th. I've reformatted the relevant question below to fit better on this site.
The actual question as worded was: "How would you describe your personal situation regarding COVID-19 vaccines?"
Two weeks left to apply for private health insurance during special enrollment period
New cost savings available when you apply through MNsure
ST. PAUL, Minn.—Do you lack health insurance or are you currently enrolled in a health plan outside of MNsure? Don’t wait to act—you have until Friday, July 16, 2021 to apply and enroll in a plan this summer thanks to MNsure’s special enrollment period, designed to help more Minnesotans get the security of health insurance during the COVID-19 pandemic.
The COVID-19 Special Enrollment Period runs through August 15th in most states, but in Minnesota it's only available through July 15th.
To explore your options, visit MNsure.org and select “COVID special enrollment” on the homepage.
Health insurance is more affordable than ever for thousands of Minnesotans who enroll in private health plans through MNsure, thanks to the American Rescue Plan.
