A couple of hours ago, the Biden White House posted a completely updated version of what's being described as a "framework" for his Build Back Better policy agenda, which has been significantly pared down from the more ambitious version last spring. There are three main reasons for this: Congressional/Senate Republicans as a whole; Senator Joe Manchin of West Virginia; and Senator Kyrsten Sinema of Arizona.

There's still no way of knowing whether or not this version of Biden's #BBB agenda will pass either, but assuming it does, here's what will make the final cut:

Back in September, the Centers for Medicare & Medicaid Services (CMS) issued several reports which touted the success of the 2021 COVID Special Enrollment Period. Thanks in part to enrollment being re-opened but mostly to the dramatically expanded financial aid provided by the American Rescue Plan (ARP), over 2.8 million additional Americans signed up for 2021 healthcare coverage via the ACA exchanges nationally.

This came on top of the 12.0 million who had already enrolled during the official 2021 Open Enrollment Period from November 1st, 2020 - January 31st, 2021. All told, that's 14.8 million Americans who selected Qualified Health Plans (QHPs) via the exchanges through mid-August.

I ran the preliminary, requested 2022 rate increase numbers for Arkansas back in August. The Arkansas Insurance Dept. is pretty good about laying out the requested rates and covered lives in a straightforward way, so it seemed pretty clear cut at the time.

The most remarkable thing about North Carolina's 2022 ACA carrier rate filings aren't the rate changes themselves--they range from -15% to +14.6%, nothing shocking--but the sheer explosion in competition coming to both the individual and small group markets.

NC's indy market is going from five carriers to ten in one shot, with Aetna, AmeriHealth, Celtic, Friday and UnitedHealthcare all jumping into the risk pool. On the small group side, there are two new entrants: Bright Health and Friday Health Plans.

In any event, overall, the average preliminary rate increase for unsubsidized enrollees is averaging 8.7%, while small group plans are going up by an average of 9.8%.

Back in early September, I wrote a post which gained quite a bit of attention in which I ran some back-of-the-envelope math to try and answer a question which is cold-hearted and tasteless...but which, nonetheless, many people across the political spectrum have been wondering: What will the real-world impact be on the 2022 midterm elections of the Red/Blue COVID divide?

There's a lot of factors which come into play here, including political messaging, narratives and the like, but let's be perfectly blunt: What people really want to know (whether they admit it or not...some have been cruder in posing the question than others) is whether more GOP or Dem voters are dying of COVID, and how much that will impact the midterms at the ballot box.

via Covered California (from a week or so ago, but still):

• The 4 percent weighted average rate change for Covered California for Small Business is the second lowest since 2014.

• Covered California’s small-business marketplace continues to expand, with more than 70,250 members to date and double-digit percentage membership growth for the seventh consecutive year.

• Covered California for Small Business also announces an expansion of its four-tier offering as employers can now choose to offer employees the option of selecting from all metal tiers effective Oct. 1. 

SACRAMENTO, Calif. — Covered California for Small Business unveiled the health plan choices and rates for small-business employers and their employees for the upcoming 2022 plan year. The statewide weighted average rate change is 4 percent, which represents the second-lowest annual increase in the program’s seven-year history. The rate change is lower than national projected increases for larger employers.

via MNsure (this is actually from a couple of weeks ago, but still):

Shop and Compare Health Coverage for 2022

ST. PAUL, Minn.—With open enrollment starting in less than three weeks, Minnesotans who need private health insurance can explore health and dental plans available for 2022 through MNsure, Minnesota’s health insurance marketplace.

MNsure’s open enrollment period starts November 1 and runs through January 15, 2022, but Minnesotans can use MNsure’s plan comparison tool now to preview insurance plans, compare options, and see what savings they may qualify for.

In every county, Minnesotans will have at least 19 separate health insurance plan options to choose from through MNsure.

via Your Health Idaho:

Open Enrollment for 2022 health insurance begins November 1

• New carriers and expanded tax credits give Idahoans more choices and savings

BOISE, Idaho – Open Enrollment for health insurance is just one week away. Beginning Nov. 1, Idahoans who do not have coverage through their employer and don’t qualify for Medicaid or Medicare, can enroll in 2022 medical and dental coverage through Your Health Idaho, the state’s health insurance exchange.

Your Health Idaho will offer a record number of plans this open enrollment period with the addition of two new insurance carriers. Molina Healthcare of Idaho and EMI Health will offer plans on-exchange for the first time, giving Idahoans more choice than ever before.

“This is an exciting year for Your Health Idaho and our customers,” said Your Health Idaho executive director, Pat Kelly. “Not only do we have two new insurance carriers and a record number of plans, but Idahoans are also seeing more savings than ever before thanks to the enhanced subsidies that are only available through Your Health Idaho.”

Here's the weekly look at the rate of COVID-19 cases & deaths at the county level since the end of June, broken out by partisan lean (i.e, what percent of the vote Donald Trump received in 2020).

The case rate is pretty much the same as it was last week, with new cases running nearly 3x higher per capita in the reddest tenth of the country than the bluest tenth...

Methodology reminders:

• 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 Hawaii, Illinois, Vermont, Virginia and West Virginia, I'm using data from the COVID Act Now Risk & Vaccine Tracker database.
  • For Colorado, Georgia, Minnesota, New Mexico, North Carolina and Texas, I'm using their COVID vaccine dashboards set up by the state health departments.
  • 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.
  • For Massachusetts, I'm using the CDC data for most counties but am now using the official Massachusetts Health Dept. weekly data report for Barnstable, Dukes & Nantucket counties, which the CDC only has partial data for.