Last year was the first year in which the Affordable Care Act's (ACA's) new health insurance exchanges were operating.  Starting in 2014, almost all Americans must now have health insurance or face a tax penalty.

Premiums varied widely.  Today's map shows the 10 most expensive health insurance markets for 2014.  Citizens can purchase a variety of plans from different private insurers.  The standard for comparison looks at Silver plans for a 40 year old non-smoker.  In 2014, the average monthly health insurance premium for a Silver plan for a non-smoking, 40 year old adult was $328/month.  Rates were lowest in 2014 in Minnesota and highest in western Colorado.

So, are there any patterns to markets with high or low premiums?  Yes.

*Some fairly wealthy areas such as western Connecticut and western Colorado have relatively healthy people but appear to be paying more.  Why?  I guess because insurers feel the markets in these areas can bear higher premiums.  That is just a guess.

*Other areas are a) remote with limited medical providers, b) are in areas where Americans are in fairly poor health, or c) both.  Georgia has the dubious honor of having 2 of the 10 most expensive markets in the country AND having the greatest disparities of any state between the high costs around Albany, GA, compared to the relatively lower costs in the Atlanta market.  Wyoming, northern Nevada, western Wisconsin, Alaska, and coastal Mississippi all have issues with few providers and/or sick populations.

*Vermont ranks in the 10 most expensive because of a policy in that state.  Unlike in other states which have opted to allow insurers to charge older residents more than younger people, Vermont law requires insurers to charge everyone regardless of age the same premium for the same plan.  As a result insurers increased premiums across the board in Vermont.

The new 2015 premiums came out in mid-November and there are relatively big fluctuations in premiums.  Minnesotans will be paying more.  Mississippians will pay less.  Overall prices nationally are either slightly down or steady after years of rapidly rising premiums.  The geography of premiums, however, continues to be sorted out as insurers and their actuaries figure out if they are charging enough to cover the health issues of their populations AND make a profit (since the Republican-invented ACA model relies on government subsidies and private insurance companies rather than the single-payer Democratic alternative).  It will likely be at least 3 years (circa 2017) before we can see more stable premium data as the system finds its groove.

The Equality State of Wyoming, the first state to allow women to legally vote, on Friday became the 32nd state to legalize civil marriage for same sex couples.

The Rapidly Changing Marriage Map

As expected, the various states in the 9th, 10th, and 4th appellate circuits are catching up this week to those courts' rulings striking down bans on same sex marriage:

• Civil marriage for same sex couples is now legal in North Carolina.  South Carolina continues to fight the ruling, but the law is fairly clear that South Carolina must also abide by the 4th circuit's ruling.  
• In the 10th circuit a Wyoming judge has said he will rule by Monday on whether to strike down Wyoming's ban.  I'm not quite sure what is going on in Kansas.
• In the 9th an Alaskan judge struck down that state's ban. Couples began marrying but the state was able to get a temporary stay.  So it has gone from blue back to pink.  And in Arizona a judge ruled today there to strike down that state's ban and marriages are starting there.  Plaintiffs in Montana are seeking the court to affirm the 9th's decision applies to Montana too.  

And while court watchers have been waiting eagerly for the ruling from the 6th, we are still waiting.

Save the Tatas

This quick map shows data from the CDC's 2010 Behavioral Risk Factor Surveillance Survey (BRFSS) broken into standard deviations.  The pale gray states represent states where the percentage of women over the age of 40 reporting they have had the recommended mammogram in the past 2 years.  Gold states have better mammogram percentages.  Purple states have worse.

Massachusetts stands out as having the highest percentage of women over 40 who have had a mammogram. This much higher percentage for the Bay State likely results from the high percentage of women who have health insurance thanks to the program signed into law by Gov. Mitt Romney that has since become the model for the Affordable Care Act.

On the other extreme are the western states of Oklahoma, Utah, Nevada, Idaho, Wyoming, and Montana where significantly lower percentages of women have had mammograms.

The Latest Marriage Map

Ye ol' marriage map keeps on changing.  Today Wyoming joins the states with a lawsuit seeking to overturn the ban on same-sex marriages.  That leaves 8 states without a current lawsuit directly seeking to legalize same-sex marriage.  Montana, Kansas, and Ohio though have lawsuits related to same-sex marriage underway.

I'm not sure what is up though with Georgia and Indiana.  I would think some lawsuits would be coming out of Atlanta, Indianapolis, Savannah, etc. with their seemingly large LGBT communities.

Many thanks to the good folks whose data updates and news briefs help me to keep this map going:

www.marriageequality.org
www.joemygod.blogspot.com/