Wellmark Blue Cross and Blue Shield is back.

A little more than a month after the Des Moines-based insurer left the state’s insurance exchange, Wellmark will return in 2019 to sell Affordable Care Act-compliant plans on and off the exchange, the company announced Thursday.

“We are predisposed to want to be in this market, so we need just enough certainty to allow us to be there and we think we now have that,” Cory Harris, executive vice president and chief administrative and legal officer, told The Gazette Thursday.

The company will offer fully ACA-compliant plans on the public exchange in all 99 counties beginning Jan. 1, 2019, “assuming there aren’t any significant changes to the Affordable Care Act,” stated a news release from the company.

Company officials said more stability in the ACA market allows Wellmark make a to return, Harris said.

“Remember last year in Washington, it was all about repeal and replace, which left our company with a lot of uncertainty about the viability about this particular market segment,” Harris said. “A lot of that has seemed to have subsided to some degree.

“That regulatory uncertainty has dissipated just enough that we think we’re able to step back in and serve the market segment that we had historically been in and we want to be in.”

Enrollment nationwide on the ACA exchange remained virtually unchanged from last year, despite efforts by President Donald Trump and other politicians to eliminate or weaken the 2010 health law. According to nationwide figures from the National Academy for State Health Policy, almost 12 million people signed up during the enrollment period for 2018 health coverage through the ACA.

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Wellmark, the state’s largest insurer, had announced in April of last year it no longer would sell subsidy-eligible plans in the exchange as of Jan. 1, 2018.

High costs and an uncertain future surrounding the ACA was the driving force behind the company’s decision. It had lost about $90 million through the individual market, officials said at the time, while individuals enrolled with those plans saw a nearly 43 percent premium increase this past year.

“The decision last year to leave the individual ACA, it was a painful one,” Harris said. “That was a lot of deliberation and was not an easy decision to make.”

The decision affected 21,400 of the company’s policyholders — about 1.6 percent of its more than 1.66 million Iowa members — who then no longer had coverage through Wellmark at the start of 2018.

Wellmark’s exit left three insurers on the Iowa exchange — Medica, Aetna and Gundersen Health Plan.

Aetna departed Iowa’s individual insurance market in April 2017, leaving Medica as the only statewide provider of ACA-compliant plans — health plans that cover certain “essential benefits” dictated by the federal law.

Gundersen sells in only five of Iowa’s 99 counties.

“We think it’s good for the market to have choice,” said Medica Vice President of Individual and Family Business Geoff Bartsh in an email to The Gazette Thursday. “Medica is very proud of our commitment to Iowa and our decision to stay in the market for 2018.

“But Iowa’s individual insurance market should work better for consumers than it does today, including having more choices. We are committed to working with others on solutions to this end.”

Wellmark pivoted from its previous decision to leave Iowa’s exchange after policyholders, Gov. Kim Reynolds and Iowa Insurance Commissioner Doug Ommen “asked Wellmark to offer individual and family coverage in this market,” Thursday’s new release from Wellmark stated.

In a guest column published June 4, 2017, in The Gazette, Wellmark Chairman and Chief Executive Officer John Forsyth said there were certain aspects of the market that needed to be addressed to “allow Wellmark and other carriers to re-enter the health insurance market in Iowa.”

Three of those aspects were:

l Ensuring a viable risk pool by bringing more people with varying degrees of health into the market.

l Tightening the rules that allow individuals to purchase insurance after they become ill.

l Requiring subsidies based on age and income to attract more diversity into the member pool.

The market “is still imperfect” and a lot of the items Forsyth set out have yet to occur, Harris said, but a firmer footing is enough for the company to return to a market “we need to be back in.”

“We’re hopeful that these things will come into being because we think there’s still ways that the ACA can still be improved, but we’re not going to let perfect be the enemy of the good,” he said.

Last year, Wellmark worked with the state to pursue the Iowa Insurance Division’s stopgap measure, an appeal for a federal waiver that aimed to stabilize the individual market by attracting young, healthy enrollees.

State officials withdrew the proposal in October after no approval came from federal leaders.

“Although federal law was not flexible enough to provide the relief needed to implement the measure, we remain committed to finding a solution,” the Wellmark release stated.

Iowa Insurance Commissioner Doug Ommen told The Gazette last month he had no plans to file the stopgap measure again, adding that the solution needs to come from the federal level.

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Harris said Wellmark is not working on any proposals specifically, such as the stopgap measure, but remains receptive and hopeful for similar initiatives.

l Comments: (319) 368-8536; michaela.ramm@thegazette.com