The Iowa state insurance commissioner is urging carriers to get into the exchange while there are still lots of potential policyholders.
Almost two months ago, when National Underwriter Life & Health checked in with Commissioner Nick Gerhart, Medicaid expansion was still in a rough and tumble period in the state legislature and no health insurance carriers had yet signed up for the federally-run but state-partnered health insurance exchange.
Now, a version of the Medicaid expansion will go forward in a version of the so-called Arkansas Compromise after Democrats and Republicans brokered a deal and the Republican Gov. Terry Branstad agreed to it. The Associated Press reported that Branstad will this week sign legislation that expands the Medicaid health care program in Iowa. Under the deal, those above the poverty line at 101 percent but below 138 percent will be given silver plans on the exchange.
However, Gerhart has seen only one carrier — and not even the first- or second-largest — sign up for the partnership exchange.
Gerhart did not disclose the name of the insurer.
Notice of intention to join the exchange for the first open enrollment period beginning Oct. 1 is due June 30.
But as he was back in April, Gerhart says he is trying to do everything he can as insurance commissioner to make the offerings as robust as possible.
Gerhart hopes to get the two largest insurers on board, and also try and convince the Office of Personnel Management (OPM) to get a multistate plan in Iowa for next year, not a few years down the road.
He brings the perspective of a son of a primary care physician and a member of a family of a multigenerational farm ownership — his family's ownership dates back to the 1840s — and has not been a money-maker, he stresses.
"A sense of urgency has come back to the exchange," Gerhart said.
There is a statewide capacity issue of the biggest carrier is not on the exchange," Gerhart added.
"It is great that you want to be there year two or three but we really need partners in year one," Gerhart said. The carriers recruited in without the big networks won't have the doctor network or experience with the population flow, although they might cover the state, Gerhart worries.
"If Wellmark [Blue Cross and Blue Shield] and United Healthcare Group had made a firm commitment, and said we will be there," that would be one thing, Gerhart said, referring to the two largest health insurers in the state. News reports give Wellmark 86 percent of the individual market in the state.
But without them, Gerhart has been beseeching OPM and the Centers for Medicare and Medicaid Services (CMS). If there is a list of which states get a multistate plan first, Gerhart said he wants Iowa to be on it.
According to the latest conversation this week with OPM, he has not gotten a sense that Iowa will get there in 2014.
Gerhart said he has been trying hard to bring in OPM despite the sense that a lot of other state regulators don't want to cede control to OPM, reflecting the same dynamic these states have with the U.S. Department of Health and Human Services (HHS).
Gov. Branstad, who before rejected Medicaid expansion and other trappings of the Patient Protection and Affordable Care Act (PPACA) is now striving to make Iowa "the healthiest state" with a message-branded initiative.
"My view is, I want to make sure for year one, I want to make sure we have options. We may have that debate later over jurisdictional issues," Gerhart said.
However, he worries that OPM has been so focused on more densely populated states.
