While numerous other states have already done the same thing (and several more are in the process of doing so as well), Georgia's move to their own enrollment platform was especially noteworthy for two reasons:
First, because it represents as complete 180-degree turn from their prior attempts (over the course of several years) to eliminate any formal ACA exchange (federal or state-based) in favor of outsourcing it to private insurance carriers & 3rd-party web brokers.
Kaiser Family Foundation Vice President Cynthia Cox posted a thread on Twitter yesterday which gives an brief overview of which of the preventative services required to be covered at no cost to the enrollee by the Affordable Care Act are actually threatened by yesterday's ruling by U.S. District Judge Reed O'Connor.
If this was any other state besides Georgia--even any other GOP-controlled state--I'd say good for them since it would presumably just mean that they were the latest state to move to their own state-based exchange (which is how the ACA was originally envisioned anyway).
This would give them the ability to hook the SBM into their state databases for auto-enrolling residents receiving SNAP benefits/etc into $0-premium coverage, or to integrate supplemental subsidies as nearly a dozen states do today, and so forth. There's several upsides to moving to an SBM, up to & including reducing the user fees (although those have been significantly reduced on the federal exchange in recent years anyway).
Idaho already has some of the most extreme abortion restrictions on the books, with nearly all abortions banned in the state and an affirmative defense law that essentially asserts any doctor who provides an abortion is guilty until proven innocent. And now Idaho Republicans have set their sights on hindering certain residents from traveling out of state to get an abortion.
More than 56,000 customers were impacted by the DC Health Link data breach, the DC Health Benefit Exchange Authority revealed Friday.
The data fields compromised were name, Social Security number, birthdate, gender, health plan information, employer information and enrollee information – address, email, phone number, race, ethnicity and citizenship status.
Some 11,000 of the exchange’s more than 100,000 participants work in the House and Senate — in the nation's capital and district offices across the nation — or are relatives.
Agencies share plan to address HUSKY Health eligibility, redeterminations and enrollment actions
HARTFORD, CT (March 27, 2023) — The Department of Social Services (DSS) and Access Health CT (AHCT) today shared a comprehensive 12-month operational and outreach plan to redetermine eligibility for HUSKY Health enrollees and resume routine public program operations. HUSKY Health is Connecticut’s Medicaid program.
Prior to the pandemic, annual redeterminations of eligibility for the Medicaid program occurred on a monthly basis during the year and terminations were processed for individuals no longer eligible for the program. During the pandemic, the termination process was paused. The federal government passed legislation, known as the Consolidated Appropriations Act of 2023, that now requires the monthly redeterminations to begin again as of March 31.
An estimated 200,000 Nevadans may be redetermined ineligible for Medicaid benefits over the next 14 months, but NevadaHealthLink.com has options to keep them insured
(CARSON CITY, Nev.) – Starting April 1, all Nevadans on Medicaid will start to have their accounts redetermined on an annual basis for the first time since before the COVID-19 pandemic, causing many Nevadans to potentially lose their health care coverage. Nevada Health Link is helping to coordinate the transfer of qualifying applications to NevadaHealthLink.com to ensure Nevadans stay covered.
A new bill introduced in the California state Senate aims to lay the groundwork for a state universal healthcare system, proposing an incremental approach that departs from recent sweeping, and unsuccessful, efforts to reshape how Californians receive care.
Under the measure by state Sen. Scott Wiener (D-San Francisco), California would begin the process of seeking a waiver from the federal government to allow Medicaid and Medicare funds to be used for a first-in-the-nation single-payer healthcare system.
“In the wake of COVID-19’s devastation, and as costs for working people have skyrocketed, the need to provide affordable healthcare to all Californians has never been greater,” Wiener said in a statement. He touted his measure as making “tangible steps on a concrete timeline toward achieving universal and more affordable healthcare in California.”
WASHINGTON, DC — President Joe Biden invited Covered California’s Executive Director Jessica Altman and other health leaders from across the country to the White House to celebrate the 13th anniversary of the enactment of the Affordable Care Act. The landmark law, which has helped provide quality health care coverage for more than 40 million Americans, represents the most significant improvement to our nation’s health care system since the passage of Medicaid and Medicare more than five decades ago.
“All Americans deserve the peace of mind that if an illness strikes or an accident occurs you can get the care you need,” President Biden said. “The Affordable Care Act has been law for 13 years; it has developed deep roots in this country and become a critical part of providing health care and saving lives.”
Nevada Health Link Celebrates the 13th Anniversary of the Affordable Care Act
Over 800,000 Nevadans have enrolled in affordable health coverage thanks to the ACA and Nevada Health Link’s ongoing community partnerships and outreach initiatives
(CARSON CITY, Nev.) – Nevada Health Link commemorates 13 years since the Affordable Care Act (ACA) was signed into law by President Barack Obama. The ACA is credited for the creation and ongoing operations of Nevada Health Link, Nevada’s state agency that facilitates the sale of qualified health and dental plans. Since the inception of the ACA, Nevada Health Link has enrolled over 800,000 individuals to get connected to budget-appropriate health coverage through the online health insurance marketplace, NevadaHealthLink.com.
Lost in all the fuss last week over the ACA's 13th anniversary, the corresponding enrollment report, and North Carolina's expansion of Medicaid to an additional 600,000 people was this announcement via the Centers for Medicare & Medicaid Services (CMS):
Biden-Harris Administration Announces the Expansion of Medicaid Postpartum Coverage in Oklahoma; 30 States and D.C. Now Offer a Full Year of Coverage After Pregnancy
Back in late January, I crunched the numbers on the total number of Americans who currently have healthcare coverage directly via the Affordable Care Act. This includes three categories: Exchange-based Qualified Health Plans (QHPs); the Basic Health Plan (BHP) progams in Minnesota and New York; and Medicaid Expansion in the 38 states (+DC) which had implemented it as of that point.
I concluded that the total numbers for each were roughly 15.4 million QHPs, 1.2 million BHPs and 23.5 million Medicaid expansion enrollees, or around 40.1 million people total.
Earlier this week, the Centers for Medicare & Medicaid Services (CMS) confirmed my estimates and even came in slightly higher, at around 40.2 million. They put effectuated QHPs at 15.6 million and Medicaid expansion enrollment at around 23.4 million.
A decade ago, when conservatives were attacking President Barack Obama’s Affordable Care Act as government encroachment in health care, they worked to amend state constitutions around the country to affirm a broad right for people to control their own medical decisions.
“Each competent adult shall have the right to make his or her own health care decisions,” reads section 38(a) of the Wyoming constitution’s Declaration of Rights, under the header “Right of healthcare access.” The provision was placed on Wyoming’s ballot by state lawmakers and approved by voters in 2012; voters saw ballot language that described the measure as preserving this right “from undue governmental infringement.”
Now these anti-ACA provisions—and their broad affirmations of a right to decide—have turned into an unlikely weapon in progressives’ fight against restrictions on abortion.
This is, of course, extremely important since household income is one of the most critical factors in calculating how much financial assistance enrollees receive, as well as whether or not they're eligible for Advance Premium Tax Credits (APTC).
If you've ever wondered why healthcare wonks (myself included) almost never even bring up the ACA's Catastrophic Level plans and why the only time I ever discuss Platinum Plans is in the context of high-CSR enrollees being eligible for "Secret Platinum" plans (labeled as Silver), this table should explain why.
Next up: Age brackets, gender, racial/ethnic groups and urban/rural communities. I'm also throwing in the stand-alone Dental Plan table for the heck of it since I don't know where else to include it.
I don't have a ton to say about any of these, really. It's always interesting to me to see that nearly 2% of ACA exchange enrollees are 65 or older. Not sure why they aren't on Medicare but I'm sure there are logical reasons.
Now it's time to move on to the actual demographic breakout of the 2023 Open Enrollment Period (OEP) Qualified Health Plan (QHP) enrollees.
First up is breaking out new enrollees vs. existing enrollees who either actively re-enroll in an exchange plan for another year or who passively allow themselves to be automatically renewed into their current plan (or to be "mapped" to a similar plan if the current one is no longer available).
Now that the official press release is out of the way, it's time to dig into the actual final, official state-level data. The table below has the final, official 2023 Open Enrollment Period (OEP) numbers for both Qualified Health Plans (QHPs) in all 50 states + DC as well as Basic Health Plan (BHP) enrollment in Minnesota and New York only, compared to the 2022 OEP.
According to the essential Louise Norris, there are currently just six states where being pregnant in and of itself makes someone eligible for a Special Enrollment Period outside of the official Open Enrollment Period:
In most states, pregnancy does not trigger a special enrollment period. HHS considered this, but clarified in 2015 that they had decided not to include pregnancy as a qualifying event. This means that in most states, the special enrollment period tied to having a baby does not begin until the baby is born.
But state-run exchanges (there are 18 of them as of 2022) can set their own rules for qualifying events and special enrollment periods. Some of them do allow a special enrollment period triggered by pregnancy. This gives a pregnant person access to health coverage during the pregnancy, rather than having to wait until the baby is born to obtain coverage. As of 2022, pregnancy is a qualifying event in the following state-run exchanges:
Requires an insurer or health maintenance organization that provides coverage under an Affordable Care Act Marketplace (Marketplace) plan to provide to each individual covered under the Marketplace plan, not more than two months before the birthday on which the individual will become 65 years of age, a written message that includes: (1) a statement that the individual will be eligible to enroll in Medicare during the individual's initial enrollment period, which begins three months before the individual becomes 65 years of age; (2) a statement advising the individual that, in most cases, someone covered by a Marketplace plan will want to end their Marketplace coverage upon becoming eligible for Medicare; and (3) detailed instructions that the individual may follow to cancel the individual's Marketplace plan.
I've grown to absolutely love the way Hawaii state legislation summarizes the situation being addressed by the bill in question; they don't hold any punches in explaining why the bill is necessary:
The legislature finds that obstacles to access to health care based solely on immigration status prevent many low-income immigrants and immigrants' families from obtaining affordable health care coverage through medicaid, the Children's Health Insurance Program (CHIP), and health insurance exchanges established under part II of the Patient Protection and Affordable Care Act.
(3) Access limited to lawful residents.--If an individual is not, or is not reasonably expected to be for the entire period for which enrollment is sought, a citizen or national of the United States or an alien lawfully present in the United States, the individual shall not be treated as a qualified individual and may not be covered under a qualified health plan in the individual market that is offered through an Exchange.
Again, this doesn't just mean that they can't get federal financial help; it means they can't enroll via ACA exchanges at all:
Undocumented immigrants aren’t eligible to buy Marketplace health coverage, or for premium tax credits and other savings on Marketplace plans. But they may apply for coverage on behalf of documented individuals.
Connecticut House Bill 6616 was introduced to the state House in February with a total of 13 cosponsors (all Democrats). Since then it's had a public hearing and has been reported favorably out of the legislative commissioners' office and to the House Appropriations Committee.
The bill seems to expand Medicaid and/or CHIP eligibility ("Husky A, B or D") to a significant number of undocumented children in the state, but it's rather densely worded, making it difficult for me to be certain just how far up the age range it applies. However, according to Louise Norris, it would extend it from the current 12-year old limit for undocumented children up to age 20 by January 2024 and age 25 by later that year, as long as their household income is still below the thresholds currently in place for those populations:
Section 17b-261 of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2024):
I had heard that this was in the works, and with the recent trend of more & more states (most recently including Georgia) splitting off from the Federally Facilitated Marketplace (FFM) hosted via HealthCare.Gov, it's hardly surprising...but it's still a pretty big deal, especially given that Illinois is the 6th largest U.S. state by population. Via Amy Lotven of Inside Health Policy:
Illinois’ Department of Insurance would be authorized to operate a state-based exchange, starting in plan year 2026, under legislation introduced late Thursday by the Illinois Democratic House Majority Leader Robyn Gabel. Sources earlier this week told IHP they had heard state officials were working with lawmakers on exchange legislation and the bill could be unveiled by this week.
So, I've been combing through a mountain of healthcare & health insurance-related legislation which has been introduced by various state legislators around the country, and this one caught my eye:
OR HB3326
Relating to changing the name of the Oregon Health Authority; declaring an emergency.
The bill summary doesn't provide much more detail:
Changes name of Oregon Health Authority to Oregon Department of Health. Makes conforming changes. Becomes operative on January 1, 2024. Declares emergency, effective on passage.
OK, so it changes the name of the health department and...declares an emergency relating to that? Huh? What?
It was introduced about a month ago by GOP state representative Werner Reschke. It doesn't have any other cosponsors from either party so far.
I decided to take a look at the actual legislative text.
New DIFS Bulletin to Protect LGBTQ+ Michiganders from Discrimination in Insurance, Financial Markets
March 17, 2023
(LANSING, MICH) The Michigan Department of Insurance and Financial Services (DIFS) has issued a bulletin that reaffirms the department’s commitment to protecting Michiganders from discrimination based on sex, sexual orientation, and gender identity in the insurance or financial services industries. The bulletin ensures that the insurance and financial services industries, including health insurance, must comply with the newly-amended Elliott-Larsen Civil Rights Act as signed into law by Governor Gretchen Whitmer yesterday afternoon.
The first section of the legislative text is about as frank and clear as I've ever seen:
The legislature finds that Hawaii has long been a leader in advancing reproductive rights and advocating for access to affordable and comprehensive sexual and reproductive health care without discrimination. However, gaps in coverage and care still exist, and Hawaii benefits and protections have been threatened for years by a hostile federal administration that has attempted to restrict and repeal the federal Patient Protection and Affordable Care Act and limit access to sexual and reproductive health care. The Trump administration made it increasingly difficult for insurers to cover abortion care and assembled a Supreme Court that restricted abortion access and that may eliminate the Patient Protection and Affordable Care Act in the near future.
The Children’s Health Insurance Program (CHIP) is offered through the Healthy and Well Kids in Iowa program, also known as Hawki. Iowa offers Hawki health coverage for uninsured children of working families.
No family pays more than $40 a month. Some families pay nothing at all. A child who qualifies for Hawki health insurance will get their health coverage through a Managed Care Organization (MCO).
Mazel Tov to Audrey Morse Gasteier, who I know via online discussions & have met a couple of times in person at the annual Families USA conference. I'm sure she'll continue to do a great job:
BOSTON — Audrey Morse Gasteier, who has served as a policy leader at the Massachusetts Health Connector for more than a decade, was named executive director of the state-based Marketplace today by Secretary of Health and Human Services and Health Connector Board Chair Kate Walsh.
Morse Gasteier had been serving as acting executive director since January.
“Since its establishment in 2006, the Health Connector has been where Massachusetts residents can find affordable health care,” said Secretary Walsh. “Audrey has been a key part of that important work for many years, and I look forward to working with her as we continue to make health care coverage accessible to everyone in Massachusetts.”
One of the most inane restrictions of the ACA in my view, as I noted in my "If I Ran the Zoo" wish list back in 2017, is that it doesn't allow undocumented immigrants to enroll in ACA marketplace health plans ("Qualified Health Plans" or QHPs).
I don't just mean that they aren't eligible for federal financial subsidies--that's a prohibition which I can at least understand, even if I don't agree with it. I mean that they aren't allowed to enroll in ACA exchange-based QHPs even at full price, as noted in Section 1312(f)(3):
As I noted last month, as we've reached the 3rd anniversary of the COVID-19 pandemic hitting U.S. shores and with the Public Health Emergency winding down, it's become more & more difficult for data analysts and researchers to acquire comprehensive, county-level data about cases, hospitalizations, deaths, vaccinations and so forth.
With two of these already discontinued and the third set to do so within the next few weeks, this story is somehow even more depressing to me (via Robert King at Fierce Healthcare; h/t Katherine Hempstead for the heads up):
Earlier today I received a first: A "cease & desist"-type email from Humana Inc's "Sales Integrity Department" asking me to remove their logo from a blog post about the company:
Dear Website Owner:
Humana encourages agents and agencies (collectively, “Agents”) to promote the Humana Brand in a manner that complies with applicable laws and Humana’s own policies and procedures.
Internet-based capabilities are providing new and interactive ways to sell Humana products and services. Although these capabilities offer tremendous opportunities, they also create responsibilities for Humana and its Agents to maintain a system of controls and monitoring.
The Sales Integrity Department at Humana has done a review of websites containing the Humana logo and we have detected your use of the logo...
Arizona Senate Bill 1292 was introduced by Democratic state Representative Rosanna Gabaldon in February. Here's the most relevant portionf of the legislative text:
Title 20, chapter 1, article 1, Arizona Revised Statutes, is amended by adding a new section 20-123, to read:
20-123. Health care insurers; requirements; prohibitions; definitions
A. Notwithstanding any other law, every health care insurer that offers an individual health care plan, short-term limited duration insurance or a small employer group health care plan in this state:
1. Shall:
(a) Ensure that all products sold cover essential health care benefits.
(b) Limit cost sharing for the coverage of essential health care benefits, including deductibles, coinsurance and copayments.
Inflation Reduction Act Tamps Down on Prescription Drug Price Increases Above Inflation
New Medicare Prescription Drug Inflation Rebate Program protects people with Medicare and taxpayers when drug companies increase prices faster than the rate of inflation
HHS announces savings for some people with Medicare on 27 Part B prescription drugs
The Biden-Harris Administration has made lowering prescription drug costs in America a key priority — and President Biden is delivering results. Today, the Department of Health and Human Services, through the Centers for Medicare & Medicaid Services (CMS), announced 27 prescription drugs for which Part B beneficiary coinsurances may be lower from April 1 – June 30, 2023. Thanks to President Biden’s new law to lower prescription drug costs, some people with Medicare who take these drugs may save between $2 and $390 per average dose starting April 1, depending on their individual coverage. Through the Inflation Reduction Act, President Biden and his Administration are lowering prescription drug costs for American seniors and families.
Sometimes the simplest bills can have huge positive impacts. California Assembly Bill 503 was introduced by Democratic Assemblymember Juan Carrillo in February.
AB 503, as introduced, Juan Carrillo. Health care: organ donation enrollment. Existing law, the Uniform Anatomical Gift Act, authorizes the creation of a not-for-profit entity to be designated as the California Organ and Tissue Donor Registrar and requires that entity to establish and maintain the Donate Life California Organ and Tissue Donor Registry for persons who have identified themselves as organ and tissue donors upon their death. Existing law provides for the Medi-Cal program, administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.
Existing law requires the department, in consultation with the board governing the California Health Benefit Exchange, to develop a single paper, electronic, and telephone application for insurance affordability programs, including Medi-Cal.
As I noted at the time, Vought's proposed budget would include, among many other horrific things, completely eliminating funding for the ACA's Medicaid expansion program as well as complete elimination of all Advance Premium Tax Credit (APTC) funding for ACA exchange-based individual market enrollees.
I went on to note that if this proposal were to somehow pass the Senate and be signed into law by President Biden (neither of which is likely to happen, to put it mildly), nearly 40 million Americans would lose healthcare coverage as a result nationally.
Below, I've broken that number out by state to give better context about just how draconian such an eventuality would be.
SACRAMENTO, Calif. — Covered California announced that 263,320 people had newly selected a health plan for 2023, continuing a trend of steady growth in recent years. The total is more than 14,000 higher than 2021’s total, and 8,000 higher than last year’s figure. In addition, more than 1.4 million Californians renewed their health insurance for 2023, bringing Covered California’s overall enrollment to 1.74 million.
“Covered California is woven into the fabric of our health care system, providing quality coverage in every corner of the state and protecting more than 1.7 million Californians,” said Jessica Altman, executive director of Covered California. “The strength in these numbers is driven by the Inflation Reduction Act, which provides increased and expanded financial help, bringing the cost of coverage within reach for millions of Californians who need health insurance.”
Obviously much of this is unlikely to actually go anywhere given House Republicans plans to almost completely defund the ACA and completely gut Medicaid overall, but as President Biden always says, "Don’t tell me what you value. Show me your budget—and I’ll tell you what you value.”
HHS Releases President’s Fiscal Year 2024 Proposed Budget
Investments address urgent needs to extend Medicare solvency, lower drug costs, bolster public health preparedness, improve the well-being of children and seniors, expand access to health care, increase the health care workforce, and advance research underlying medicine, public health, and social services
In my post a few weeks ago about Minnesota's plan to dramatically expand their existing Basic Health Plan (BHP) program, MinnesotaCare, into a full-fledged Public Option open to residents not currently eligible for the program, I made an offhand reference to similar BHP expansion-related news happening in New York State. However, I haven't gotten around to actually writing about NY's BHP program until now.
New York's implementation of the ACA's BHP provision (Section 1331 of the law) is called the Essential Plan, and it already serves over eleven times as many people as Minnesota's does (around 1.1 million vs. 100K). Part of this is obviously due to New York having a larger population, but that's only part of it (NY has 19.84M residents, just 3.5x higher than MN's 5.71M).
Last fall I noted that Oregon (along with Kentucky, although it looks like the latter got cold feet later on) may end up becoming the third state (after Minnesota and New York) to create a Basic Health Plan program which would provide comprehensive, inexpensive (or potentially free) healthcare coverage for residents who earn between 138% - 200% of the Federal Poverty Level (FPL)...basically, the next income tier above the cut-off for ACA Medicaid expansion. A few days ago, the state legislature passed a bill which would create a task force to put together their findings and recommendations no later than September 1st of this year.
I didn't actually get around to writing up the post until June, but I actually bought the car, a 2022 Kia Niro EV, in early March...March 5, 2022 to be precise, almost exactly one year ago.
With a year of real world driving (including an 1,100 mile (round trip) road trip from Metro Detroit to the District of Columbia) baked in, I figured this would be a good time to post an update on how things are going for those who've never owned an EV and are wondering about the good, the bad & the ugly of the experience.
Before I get started, I should take a moment to note that the EV industry and market have both gone through some tumultuous changes over the past 12 months, including (but not limited to):
As of this writing, 69.3% of the total U.S. population has completed their primary COVID-19 vaccination series (including 94.3% of those 65+), but a mere 16.2% of the total population has also gotten their updated bivalent booster shot. Even among seniors it's only at 41.4% nationally.
Harrisburg, PA – At the conclusion of Pennie’s Open Enrollment Period on January 15th, nearly 372,000 Pennsylvanians were enrolled in a comprehensive health plan. Almost 245,000 Pennsylvanians were automatically renewed into a 2023 plan, another 62,000 existing customers returned and shopped for a plan, and nearly 65,000 new enrollees joined the marketplace in 2023.
Pennie provides significant savings on health coverage to improve access to health care and to counter rising costs. Almost 90 percent of total customers are receiving financial savings, which on average, is more than $520 a month for those customers. With these savings, over 32 percent of customers pay less than $50 a month for coverage, and over 50 percent of customers pay less than $150 a month.
4,318 Rhode Islanders are newly insured, supporting state’s outstanding insured rate of 97%
PROVIDENCE – HealthSource RI (HSRI) announces that its annual Open Enrollment period has concluded as of January 31, with 4,318 Rhode Island residents newly enrolled in the affordable qualified health plans available through the state marketplace. An additional 24,343 individuals, or 83% of last year’s customers, renewed their coverage during the same period starting November 1.
That's 28,661 QHP selections total, down 11.4% from the 2022 Open Enrollment Period.
“We’re encouraged that each year more Rhode Islanders are taking advantage of the quality, affordable coverage options available to them through HealthSource RI,” said Governor Dan McKee. “Rhode Island continues to be a national leader in health coverage and HSRI is an instrumental piece of the effort to maintain our extraordinarily high rate of insurance coverage.”
UPDATE 3/15/23: The agreed-to Medicaid expansion deal has passed the NC State Senate! It now just needs to pass the state House one final time and then it's on to Gov. Cooper's desk to be signed into law!
UPDATE 3/8/23: HB 400 just overwhelmingly passed the New Mexico House!
HUGE NEWS! #HB400 just passed the House Floor by a vote of 58-10! Huge thanks to Rep. @reenaszcz & Speaker @JavierForNM for their work carrying #MedicaidForward through the House of Representatives & to everyone who reached out to their legislator. On to the Senate! #nmleg#nmpol
— NM Together for Healthcare (@NMT4HC) March 8, 2023
Well, the lines didn't flip after all in January--the reddest quintile jumped up faster than the bluest quintile after all--two months earlier than I expected:
Bluest Quintile: 4.70 per 100K residents
Reddest Quintile: 5.33 per 100K residents (13% higher)
The January gap wasn't that significant by itself...except that it had looked like the rate in the reddest quintile might be lower last month.
Sure enough, the COVID death rate gap between the reddest and bluest fifths of the country widened out more in February, with the rate in the reddest quintile running 63% higher than the bluest quintile (4.22/100K vs. 2.39/100K). The rate actually dropped from January to February in every quintile, but it dropped considerably more in the bluest fifth (to the lowest rate since April 2022) than the reddest.
