Methodology reminders, including some important updates:
I go by FULLY vaccinated residents only (defined as 2 doses of the Pfizer or Moderna vaccine or one dose of the Johnson & Johnson vaccine).
I base my percentages on the total population, as opposed to adults only or those over 11 years old.
For most states + DC I use the daily data from the Centers for Disease Control, but there are some where the CDC is either missing county-level data entirely or where the CDC data is less than 90% complete at the county level. Therefore:
For California, I'm using the CDC data for most counties and the state health dept. dashboard data for the 8 small counties which the CDC isn't allowed to post data for.
The 5 major U.S. territories don't vote for President in the general election, preventing me from displaying them in the main graph, but I have them listed down the right side.
Assuming the first case was ~December 15th or so, it was roughly 325 days from then until the Presidential Election on November 3rd, 2020, or a little under 11 months.
It's been 327 days from Election Day through September 26, 2021.
In other words, almost exactly as much time has passed in the post-election phase of the COVID pandemic as in the pre-election phase.
Nebraska doesn't even bother listing indy/small group plan rate filings on their own insurance department website...the link goes directly to the federal Rate Review database. The problem with this is that very few filings here are unredacted, which means it's difficult to acquire the policy enrollees for many carriers needed to run a weighted average.
Fortunately, Nebraska has only 3 carriers for 2022...one of which is brand new to the state (Oscar Health), and of the other two, Medica's filing summary does include an exact number of enrollees. That leaves just Bright Health, and since I know (roughly) how many enrollees are in Nebraska's overall indy market, voila: 8.6% average rate increases.
On the other hand, I don't have the enrollment for any of the 4 Small Group market carriers. It also looks like UnitedHealthcare is pulling out of the NE sm. group market, but it might just be that the federal database doesn't have them listed yet (I doubt this since it's so close to the Open Enrollment Period). The unweighted average rate change is a 2.1% reduction:
Seriously, if every state displayed their annual rate filing data in as simple and clear-cut a fashion as Montana does, I'd be a much happier man. Admittedly, several others do, but the trickiest issue is usually getting the estimated enrollment numbers.
In any event, not much to say about Montana's ACA markets in 2022: No new carriers are jumping in, no current ones are dropping out, and the rate changes are pretty straightforward: +0.5% on the individual market, +5.2% on the small group market.
UPDATE 10/22/21: Well, it looks like the Montana Insurance Dept. has signed off on all 7 rate filing requests without making any changes, so I guess these are the approved rate changes as well:
Georgia's health department doesn't publish their annual rate filings publicly, but they don't hide them either; I was able to acquire pretty much everything via a simple FOIA request which was responded to within a few hours of my asking.
As of 2021, there are six insurers that offer exchange plans in Georgia. Five additional insurers plan to join them for 2022: Friday Health Plans, Bright Health, Aetna, UnitedHealthcare, and Cigna (Aetna, UHC, and Cigna all participated in Georgia’s exchange previously, but left at the end of 2016).
It's worth noting that each market has a new entrant for 2022: Aetna is joining the individual market while Cigna is jumping into the off-exchange Small Group market.
The differences in enrollment noted for some carriers is likely due to some product lines being discontinued--for instance, if Celtic drops premiums by 3.1% on most of their policies but discontinues some others entirely, those enrolled in the discontinued lines won't have any official rate change to their existing policies.
Florida state law apparently gives private corporations wide berth as to what sort of information, which is easily available in some other states, they get to hide from the public under the guise of it being a "trade secret."
In the case of health insurance premium rate filing data, that even extends to basic information like "how many customers they have."
Cigna is joining the Mississippi exchange for 2022, bringing the total number of participating insurers to three. According to ratereview.gov, the following average rate changes have been proposed by Mississippi’s current exchange insurers:
The Minnesota Commerce Dept. has posted preliminary 2022 ACA rate filings for the individual and small group markets. Final/approved rate changes will likely be posted in just a few weeks.
Overall I don't see any significant changes to the offerings from 2021 other than PreferredOne appearing to eliminate one of their two lines on both markets. Also, UnitedHealthcare of Illinois appears to be scrapping their entire line of existing plans on the small group market and replacing them with all-new policies, which means there's technically no current rates for them to compare against.
The other important thing to keep in mind for the small group market is that I can't seem to find the actual current enrollment data for each carrier, so I'm basing the weighted average on 2020 enrollment, which could be way off if there's been significant market share shifts this year.
State Receives Marketplace Modernization Grant, Awarded by Centers for Medicare & Medicaid Services (CMS) Under American Rescue Plan Act
ALBANY, N.Y. (September 17, 2021) – NY State of Health, the state’s official health plan Marketplace, today announced it has been awarded a Marketplace Modernization Grant by the Centers for Medicare & Medicaid Services (CMS). This funding, a total of $1.1 million dollars, the maximum awarded to state-based marketplaces, has been made available by the American Rescue Plan Act (ARPA) of 2021 for the purpose of modernizing or updating state technology systems and/or conducting targeted consumer outreach activities that can improve access to health coverage for consumers.
Access Health CT Awarded $1.1M Grant From The Centers For Medicare and Medicaid Services
Grant funding supports the implementation of the American Rescue Plan Act in Connecticut and several technology upgrades improving the consumer experience
HARTFORD, Conn. (September 20, 2021)—Access Health CT (AHCT) announced today it was recently awarded $1.1 million of grant funding from the Centers for Medicare and Medicaid Services (CMS). The grant will be used to financially support the implementation of the American Rescue Plan Act (ARPA) helping to make health insurance more affordable for Connecticut residents, along with technology modernization projects that will enhance consumer experiences within the online customer portal. The grant funding was made possible through the ARPA.
CMS Extends Open Enrollment Period and Launches Initiatives to Expand Health Coverage Access Nationwide
The Biden-Harris Administration, through the Centers for Medicare & Medicaid Services (CMS), is taking a number of steps that will make it easier for the American people to sign up for quality, affordable health coverage and reduce health disparities in communities across the country. Beginning this year, consumers will have an extra 30 days to review and choose health plans through Open Enrollment, which will run from November 1, 2021 through January 15, 2022, on HealthCare.gov.
I've received an important reminder from the folks at HealthCare.Gov:
Continued Enrollment Opportunity for Consumers with Unemployment Compensation
The American Rescue Plan (ARP) provides additional savings to help consumers access affordable, quality health coverage options, including expanded opportunities for those who received or are approved to receive unemployment compensation in 2021.
Starting July 1, 2021, the Centers for Medicare & Medicaid Services (CMS) added a new function to HealthCare.gov to allow consumers who receive or are approved to receive unemployment compensation for any week beginning during 2021 to access new savings on health insurance coverage, if they qualify.
NY State of Health Enrollment Continues to Surge as More New Yorkers Sign Up for Low-Cost Coverage Following the American Rescue Plan and Enhancements Made to New York’s Essential Plan
Federal COBRA Subsidies are Ending This Month, but Minnesotans Have Affordable Health Coverage Options Through MNsure
ST. PAUL, Minn.—The federal subsidy for Consolidated Omnibus Budget Reconciliation Act, or COBRA, expires on September 30. The subsidy, part of the American Rescue Plan stimulus package, has helped unemployed Minnesotans who chose to continue with their workplace health insurance plan stay covered during the COVID-19 pandemic.
“Minnesotans who are losing this COBRA subsidy and are looking to keep their health care costs low should visit MNsure.org today to check out their health coverage options and see how much they can save,” said MNsure CEO Nate Clark. “Avoiding a gap in health coverage is more important than ever, so don’t wait.”
SACRAMENTO, Calif. — Covered California announced on Thursday that executive director Peter V. Lee has informed the board that he will leave the organization in early 2022. Lee has served as Covered California’s first and only executive director, helping launch the exchange in 2012 and leading the organization that has provided millions of Californians with access to affordable, quality health coverage.
“I’ve been privileged to be part of the Covered California team and the broader effort in this state to do everything we can to use the Affordable Care Act to expand coverage and ensure those with coverage get the right care at the right time,” Lee said. “I will be stepping down as Covered California’s executive director after the upcoming open-enrollment period, with pride and confidence in the team at Covered California, who have taught me so much and who are poised to continue our important work.”
Methodology reminders, including some important updates:
I go by FULLY vaccinated residents only (defined as 2 doses of the Pfizer or Moderna vaccine or one dose of the Johnson & Johnson vaccine).
I base my percentages on the total population, as opposed to adults only or those over 11 years old.
For most states + DC I use the daily data from the Centers for Disease Control, but there are some where the CDC is either missing county-level data entirely or where the CDC data is less than 90% complete at the county level. Therefore:
For California, I'm using the CDC data for most counties and the state health dept. dashboard data for the 8 small counties which the CDC isn't allowed to post data for.
The 5 major U.S. territories don't vote for President in the general election, preventing me from displaying them in the main graph, but I have them listed down the right side.
NEW: Until now I've been using 2016 election data for Alaska; starting today, thanks to an updated analysis by RRH Elections, I'm finally able to use 2020 election results for Alaska (all other states +DC have been using 2020 county-level election data all along).
So, what does this mean for the final SEP push (again, it runs through 8/15 in most states)?
Well, it's hard to say, but I'd imagine it'll be a bit higher than the last week of July. That would mean something like ~220,000 more QHP selections via HC.gov states, and perhaps another 85,000 or so via the state-based exchanges (assuming they still make up roughly 28% of the national total). If so, that would put the final 8/15 tally at around 2.86 million new enrollees during the 2021 COVID SEP nationally (~2.05 million via HC.gov, ~808K via the SBMs).
Moments ago, via the HHS Dept (oddly, not via the Centers for Medicare & Medicaid (CMS), which usually publishes these enrollment reports):
Massachusetts, which is arguably the original birthplace of the ACA depending on your point of view (the general "3-legged stool" structure originated here, but the ACA itself also has a lot of other provisions which are quite different), has 9 different carriers participating in the individual market. MA (along with Vermont) has merged their Individual and Small Group risk pools for premium setting purposes, so I'm not bothering breaking out the small group market in this case.
Getting a weighted average for Massachusetts is trickier than in most states, for a couple of reasons. The good news is there's an August 2021 enrollment report which breaks out exactly how many MA residents are enrolled in each carrier's policies. However, the numbers are actually broken into 4 different categories: Small Group (which, again, is merged with the individual market in MA); "ConnectorCare" individual market policies; subsidized Qualified Health Plans and unsubsidized QHPs.
Health Carriers Propose Affordable Care Act (ACA) Premium Rates for 2022 Public Invited to Submit Comments
BALTIMORE – The Maryland Insurance Administration has received the 2022 proposed premium rates for Affordable Care Act products from health carriers. Health carriers are seeking a range of changes to the 2021 premium rates for plans sold in Maryland’s Individual Non-Medigap (INM) and Small Group (SG) markets in 2021.
Not much is changing next year--average individual market premiums will be dropping by 2.1%, while average small group rates will be going up 3.1%. There's a new entry into Maine's small group market (UnitedHealthcare of New England, not to be confused with UnitedHealthcare Insurance, which is already offering small group policies).
They break out the filings not between Individual and small group markets or on- vs. off-exchange policies, but between rate increases over and under 10%. Normally that would be fine, but they also have multiple listings within each market for several carriers; HMO Louisiana, in fact, has 11 entries, each for a different product line, making it tedious and difficult to piece together the weighted average rate change and current enrollment for the carrier as a whole.
In addition, it looks like the state regulators have given final approved rate changes for 2022 in some cases but not others...even within the same carrier and market.
As a result, my weighted averages below may be off somewhat.
With that in mind, it looks like Louisiana's individual market is looking at final average rate hikes of 4.75%, while their small group market carriers are seeking preliminary increases of around 6.9%.
Well, this was inevitable: I got so far behind on my annual ACA rate filing project that the final/approved rates have started to be released before I even get around to some of the preliminary/requested rate filings.
The Kentucky Insurance Dept. has posted both the requested and approved 2022 rate filings for the individual and small group markets, and in addition to drastically slashing the average premiums for Anthem's individual market offerings and Aetna's small group offerings, there's also two new entrants into Kentucky's individual market: Molina and WellCare.
Overall, individual rates are dropping by around 3.8% on average (the carriers had requested a 2.7% increase), while small group market plans are increasing by 10.4% on average (very close to the 10.7% average request).
Back in late July, I posted an analysis which looked at the COVID-19 vaccination rate across all 3,144 U.S. counties, parishes & boroughs by two additional criteria: Population Density and Urban/Rural Status.
As I noted at the time, it's reasonable to assume there might be a strong correlation by these criteria, since it's presumably 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?
Methodology reminders, including some important updates:
I go by FULLY vaccinated residents only (defined as 2 doses of the Pfizer or Moderna vaccine or one dose of the Johnson & Johnson vaccine).
I base my percentages on the total population, as opposed to adults only or those over 11 years old.
For most states + DC I use the daily data from the Centers for Disease Control, but there are some where the CDC is either missing county-level data entirely or where the CDC data is less than 90% complete at the county level. Therefore:
For California, I'm using the CDC data for most counties and the state health dept. dashboard data for the 8 small counties which the CDC isn't allowed to post data for.
The 5 major U.S. territories don't vote for President in the general election, preventing me from displaying them in the main graph, but I have them listed down the right side.
An estimated 138,000 Californians face significantly higher health insurance premiums when their federal COBRA subsidies come to an end on Sept. 30.
Covered California opened a special-enrollment period to give eligible COBRA recipients an opportunity to switch their coverage and potentially save hundreds of dollars a month on their health insurance.
Many of those consumers will be able to stay with their same brand-name insurance company when they switch to Covered California.
People who sign up by Sept. 30 will have their coverage start on Oct. 1.
SACRAMENTO, Calif. — Covered California announced a special-enrollment period for Californians who will soon be losing the federal financial help that is allowing them to continue receiving health insurance through the Consolidated Omnibus Budget Reconciliation Act, better known as COBRA. Under one provision of the American Rescue Plan, Californians have been eligible for financial help that pays 100 percent of their COBRA premiums from April 1 through Sept. 30.
Aside from the massive public health fallout, this fact has all sorts of poltiical implications as well, of course. Most of those involve pundits speculating about "the blame game" and so on; will voters in states like Florida and Texas blame their governors for doing everything possible to stymie reasonable pandemic safety measures such as mask mandates, or will they blame the Biden Administration for...I don't know, not tying people to a chair and manually forcing the COVID vaccine into their arms?
For weeks now, however, people have been asking me an even more basic, crass question about the impact of political tribalism on the 2022 midterm election:
For the past couple of months now, most of my COVID scatter-plot charts...whether measuring vaccination rates, new case rates or new death rates...have been based primarily on partisan lean. That is, at both the state and county levels, I've been using the percent of the 2020 Presidential vote won by Donald Trump as the basis for comparison.
I've also looked at vaccination rates by other criteria, of course: Population density, urban vs. rural status, education level and median household income levels...but none of these have had nearly as high a correlation as sheer partisan lean has (although I haven't checked any of those in over a month; perhaps the situation has changed by now).
A couple of years ago, Washington became the first state to implement their own "Public Option" ACA healthcare plan...sort of. The actual version of the PO which was implemented ended up being considerably less impressive than the original vision, but hey, it was a start.
I've gotten a lot of attention for my COVID "scatter plot bubble graphs" over the summer, laying out the COVID vaccinationandcase/death rates across every county nationally (well, mostly; Nebraska has stopped posting county-level data entirely, and Florida has only been posting county-level case data, not deaths, since June).
Data visualization is a tricky thing, though; sometimes line graphs are the way to go (that's what I did last year); other times scatter plots are more appropriate. But some people don't "get" either of these, so today let's look at some bar graphs.
Record Numbers of Washingtonians Sign Up for Health Care Coverage During 2021 Special Enrollment Period
LATEST DATA SHOWS IMPACT OF AMERICAN RESCUE PLAN ACT SAVINGS. NEARLY HALF OF ALL CUSTOMERS PAY LESS THAN $100 PER MONTH.
Washington Health Benefit Exchange (Exchange) announced on Tuesday more than 57,000 Washingtonians signed up for health care coverage between February 15 and August 15 on the state’s insurance marketplace, Washington Healthplanfinder. The Exchange opened a Special Enrollment Period in February in response to the COVID-19 Public Health Emergency. This allowed any individual in Washington the opportunity to apply for coverage or compare and upgrade their existing insurance.
