Iowa has come up with a proposal for stabilizing its individual major medical insurance market in 2018.
The state is asking the federal government for permission to replace the state's current Affordable Care Act public exchange program with a new, state-run program.
Officials at the Iowa Insurance Division say in a proposal summary that they need to replace the current system because insurers are abandoning it.
About 72,000 Iowa residents now use individual major medical policies written under the Affordable Care Act rules that took effect in January 2014.
Some states, including New York, Oregon and Washington, have received 2018 individual major medical product filings from multiple carriers, but Iowa looks as if it's on track to have no individual major medical issuers in most counties, Iowa officials say.
Iowa claim costs have been high, the federal government has failed to make the Affordable Care Act risk corridors program insurer support payments it promised, and, today, uncertainty in Washington has made a bad situation worse, officials say.
"This uncertainty also prevented Iowa state legislators from enacting legislation during its sessions that might have supplemented any solutions from the federal level on this issue," officials say.
If Iowa wins approval for its proposal, it's possible that other states could end up converging on the Iowa model for 2018.
Here's a look at some highlights from the proposal.
1. Iowa is trying to color within the Affordable Care Act lines.
The Affordable Care Act itself includes a provision, Section 1332, that lets states propose alternatives to the standard Affordable Care Act commercial health insurance and Medicaid rules.
President Donald Trump has issued an executive order encouraging federal agencies to do what they can to minimize any burdens imposed by the health law while his administration works to replace it.
(Image: Centers for Medicare and Medicaid Services)
Iowa is asking the Centers for Medicare and Medicaid Services, the agency that runs the public exchange program and many other federal health programs, to consider its proposal either as a Section 1332 Affordable Care Act rule waiver request or as a request for Affordable Care Act burden relief.
(Related: Price Reboots ACA Reboot Program)
The state has also tried to come up with a program design that would offer coverage that would comply with the current Affordable Care Act coverage standards.
Iowa officials note that the administration of former President Barack Obama eased Affordable Care Act requirements at times. One major example is the administration's move to create "grandmothering," officials say.
Originally, the Affordable Care Act was supposed to let people keep health coverage written before March 23, 2010, when the main part of the statutory package became law, even if the old, "grandfathered" coverage failed to meet the new Affordable Care Act standards.
The grandmothering system let insurers, states and policyholders keep health coverage written between March 23, 2010, and Jan. 1, 2014, in effect after Jan. 1, 2014, even though the policies did not qualify for grandfather status and did not comply with Affordable Care Act rules.
