Iowa may be first state with no health insurers on exchange

DES MOINES, Iowa (AP) — Iowa could be the first state in the nation with no health insurance company willing to offer policies on its Affordable Care Act exchange next year unless President Donald Trump's administration approves a stopgap proposal, Iowa Insurance Commissioner Doug Ommen said today.

Ommen said he and officials from two major Iowa insurance carriers met last week with Centers for Medicare & Medicaid Services officials in Washington to pitch a proposal that would save the Iowa market from collapsing.

Several counties in Ohio, Missouri, and Washington state have no insurer for next year, but Iowa would be the first state to lose all insurers on an ACA exchange.

"While legislation appears to slowly be moving at the federal level, it is unlikely any changes to the ACA will be enacted in time to keep Iowa's individual health insurance market from a total collapse leaving nearly 72,000 individuals with zero options to purchase health insurance for 2018," Ommen said in the proposal to federal officials.

He is seeking a waiver from the ACA that would allow Iowa to reallocate federal subsidies currently used to lower costs for low-income and older participants. He proposes using them to entice younger people into the insurance market and using federal reinsurance dollars to help insurers absorb high-cost claims.

Ommen said thousands of young healthier people have fled the Iowa market as insurance rates increased, leaving a higher number of older, sicker people in a smaller individual market pool. That drove up costs and left insurance companies losing millions of dollars.

Minnesota-based Medica is the only company offering coverage across Iowa that hasn't announced that it will stop selling health insurance on the ACA exchange next year. Ommen said the company indicated it's likely to drop out if changes aren't made soon.

During the first week of April, Wellmark Blue Cross & Blue Shield and Aetna announced they were pulling out of the Iowa market. That followed the withdrawal of United Healthcare in April 2016 and the failure in early 2015 of an insurance cooperative CoOpportunity that had been set up by the ACA law.