- Iowa’s insurance commissioner is proposing a “stopgap” plan to bolster the state’s Affordable Care Act (ACA) exchange market. It calls for an $80 million contribution from the federal government.
- The plan includes a reinsurance program to help cover high-cost beneficiaries and changes to premium support payments, including more help for younger enrollees and no income cap.
- The commissioner, Doug Ommen, and representatives of payers that operate in Iowa visited Washington D.C. last week to discuss the plan with CMS Administrator Seema Verma, who seemed willing to be flexible, according to the Des Moines Register.
Iowa is not alone in its struggle to maintain an effective exchange market. States such as Nebraska, Missouri and Ohio have counties where no insurers will be offering plans. Iowa’s proposal has potential to help the state, but payers say they will not yet commit to reverse plans to pull out of the market even if the plan is approved.
For months, payers have implored the White House or Congress to authorize cost-sharing reduction payments the insurers have received in previous years. As there has not yet been any word from D.C., payers are pulling out of exchange markets every few days, citing financial concerns. They face a deadline for determining their participation in a little more than a week.
Iowa’s plan seems to play off a provision in the ACA that allows states to apply for waivers that would exempt them from some ACA regulations as long as they maintain certain coverage requirements. Verma and HHS Secretary Tom Price have both been vocal advocates of the waivers and in putting more healthcare authority in the hands of state officials.
Two Iowa payers, Medica and Wellmark Blue Cross Blue Shield, say they might reconsider plans to exit the exchanges if the proposal goes through. Aetna says its decision to leave won’t change.
The change to premium subsidies is meant to entice younger and healthier people to the exchange, an effort the ACA has also attempted, without much success. Payers outside of Iowa will be interested in seeing how the experiment plays out, if it is approved. States considering ACA waivers will be watching as well, to see what parts of the plan are approved and how successful they are.