Millions of Americans are nervously awaiting the official ruling on the fate of the Affordable Care Act in response to the CA v. TX lawsuit (previously Texas vs. U.S. or Texas vs. Azar, though I've given it the hashtag #TexasFoldEm due to the Trump Administration's Justice Department deciding to not only throw the fight but to actively support the plaintiffs against the law of the land).

While the U.S. Supreme Court isn't expected to issue their decision until April at the earliest, it's possible that they'll publish their ruling earlier than that...potentially as soon as this Thursday morning, February 25th.

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.

I've made some more changes:

• Every county except those in Alaska lists the 2020 Biden/Trump partisan lean; Alaska still uses the 2016 Clinton/Trump results. 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 these updates in mind, here's the top 100 counties ranked by per capita COVID-19 cases as of Friday, February 19th, 2021 (click image for high-res version).

Blue = Joe Biden won by more than 6 points; Orange = Donald Trump won by more than 6 points; Yellow = Swing District

A picture is worth 1,000 words and all that.

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 utterly dwarfed by North & South Dakota, although things are getting pretty horrible everywhere now.

1 out of every 8 residents of North & South Dakota's entire populations have tested positive for COVID-19 over the past year.

Rhode Island is up to over 1 out of every 9 residents.

Utah, Tennessee, Arizona, Iowa, Oklahoma and Arkansas, Nebraska and Kansas are up to 1 out of every 10 residents.

41 states have seen at least 1 out of every 15 residents test positive.

EVERY state except Washington, Oregon, Maine, Hawaii & Vermont (along with 4 U.S. territories) have now surpassed 1 out of every 20 residents having tested positive.

President Biden's nominee to run the Centers for Medicare & Medicaid Services (CMS) has been a hotly-debated topic among healthcare wonks for a couple of months now. He announced that he was picking California Attorney General Xavier Becerra as his HHS Secretary back in early December, but who would be running CMS (basically the 2nd most-powerful position within the HHS Dept.) has been a big unknown until a few days ago, when Dan Diamond and Amy Goldstein of the Washington Post scooped the story.

I admit to never having heard of her until her name was mentioned as a possible contender in a few articles last month, but if confirmed, I'll probably be mentioning her name fairly often over the next few years (likely even more frequently than Becerras), so I figured I should post a quick profile of her today.

Here's the official White House statement:

Over at the Journal of Healthcare Finance, David Anderson, Sih-Ting Cai and Jean Marie Abraham have published an interesting idea which I've never thought about before:

In 2019, CMS (2020b) began publishing its Quality Rating System (QRS) for incumbent insurers who sell qualified health plans in the individual market. This information includes scores for medical care, member experience, and plan administration which are then rolled up into an overall, global quality rating (GQR). Recent research has shown notable variation by plan characteristics for behavioral health quality (Abraham, et al., 2021) and plan administration scores (Anderson, et al., 2020). CMS hopes this information is used by consumers to make enrollment decisions.

While all 50 states & DC have now re-launched (or are about to) a new, special 2021 COVID Enrollment Period, the official 2021 Open Enrollment Period ended in every state as of January 31st.

A few of the state-based exchanges have already released their 2021 OEP summary reports, and today Access Health CT posted theirs...and it's chock full of juicy data nuggets. Let's dive in!

Note: I haven't included every single slide, but most of them are shown. Use the link above if you want to view the rest of them. Click the images for a high-res version of each:

via Pennie, Pennsylvania's new state-based ACA exchange:

Pennie Opens a COVID-19 Enrollment Period Which Will Run Until May 15

• Uninsured Pennsylvanians or those affected by COVID-19 can visit pennie.comand enroll in a plan through May 15.  

 Harrisburg, PA – February 17, 2021 – Uninsured Pennsylvanians can act now and enroll in 2021 coverage during Pennie’s COVID-19 Enrollment Period. Pennie, Pennsylvania’s state-based health insurance marketplace, is proud to provide individuals across the Commonwealth additional time to enroll in health insurance to protect them and their families from the cost of the COVID-19 virus. This enrollment period is in-line with President Biden’s recent Executive Order and is open for all Pennsylvanians who have been impacted by COVID-19. Anyone otherwise eligible to enroll in coverage through Pennie™ can do so from now until May 15.

As I've expected, though I'm pretty irritated that they still haven't released any enrollment data to date. Via NY State of Health:

Press Release: Governor Cuomo Announces Open Enrollment for New Yorkers is Extended to May 15 as Federal Marketplace Reopens for Millions of Americans

• New Yorkers Can Apply Now For Health Coverage Through NY State of Health or Directly Through Insurers
• Aligns New York with the Federal Marketplace and Numerous State Marketplaces Extending Enrollment

As COVID-19 Response and Vaccine Distribution Continues Statewide, High-Quality Health Insurance More Important Than Ever

This afternoon, the Congressional Budget Office released their 10-year "score" report of the largest single chunk of the House Democrats version of the American Rescue Plan from the Ways & Means Committee:

Legislation Summary

S. Con. Res. 5, the Concurrent Resolution on the Budget for Fiscal Year 2021, instructed several committees of the House of Representatives to recommend legislative changes that would increase deficits up to a specified amount over the 2021-2030 period. As part of this reconciliation process, the House Committee on Ways and Means approved legislation on February 10 and 11, 2021, with a number of provisions that would increase deficits. The legislation would extend unemployment benefits, establish a pandemic emergency fund, increase subsidies for health insurance, provide cash payments to eligible people, expand several tax credits, and modify rules for pensions, among other provisions designed to mitigate the impact of the COVID-19 pandemic caused by the coronavirus.

Fire up the Wayback Machine, Sherman:

May 12, 2016:

Health Insurer Aetna Inc on Wednesday said it plans to continue its Obamacare health insurance business next year in the 15 states where it now participates, and may expand to a few additional states.

"We have submitted rates in all 15 states where we are participating and have no plans at this point to withdraw from any of them," said company spokesman Walt Cherniak. But he noted that a final determination would hinge on binding agreements being signed with the states in September.

Aetna sells the individual coverage on exchanges created by the Affordable Care Act, also called Obamacare. By also filing proposed rates in several other states, Aetna said it had preserved its options to participate in them as well next year. It declined to identify the potential new markets.

The 15 states where it currently participates are Arizona, Delaware, Florida, Georgia, Illinois, Iowa, Kentucky, Missouri, Nebraska, North Carolina, Ohio, Pennsylvania, South Carolina, Texas and Virginia.