Iowa’s insurance commissioner is asking the federal government to approve a plan that could keep the state’s individual health insurance market from collapsing. It’s possible the state could have no insurers selling individual plans on the Affordable Care Act exchange in 2018.
Insurance Commissioner Doug Ommen says tweaking the ACA could stabilize the state’s individual market and make it more attractive to insurers.
"We tried to take the existing framework and reconstruct a market that has collapsed," Ommen says. "I think it may mean some challenges for those individuals. But our proposal is to have a market, versus not have a market."
Wellmark Blue Cross Blue Shield—which announced in April it would stop offering ACA-compliant plans in Iowa—has committed to selling insurance throughout the state if this plan is approved.
The proposal would shift some insurance subsidies from older people to younger people, to encourage younger, healthier Iowans to buy insurance. The proposal also creates a reinsurance mechanism—requiring additional federal funds—to help cover costs of more expensive, chronic conditions.
Ommen says older people on the exchange would likely still see their premiums increase under this plan.
"I view this as the single option that will restore insurance availability in all 99 counties," Ommen says.
He says he’s optimistic that federal officials will help the state provide coverage for the 72,000 Iowans who buy insurance on the exchange. He says this is a "stopgap measure" to hold Iowa over until the U.S. Congress passes a new healthcare bill.
The proposal would allow each insurance company to offer just one plan on the exchange, rather than the different levels of coverage currently available. The plans would cover essential health benefits and pre-existing conditions, following rules set by the ACA.
The state is taking comments and scheduling public hearings on this proposal.