Effective January 1st, 2018, 72,000 Iowans will lose their insurance coverage through the Iowa Insurance Exchange (Obamacare). Thousands of Iowans are facing an imminent emergency with the pullout of the three primary insurance carriers-Wellmark, Aetna and Medica. It will be a catastrophic blow to those Iowa families participating in the Iowa Obamacare Exchange.

Several Iowa Democratic legislators are proactively attempting to find a solution before the January cut-off. They held a public meeting in May to begin the discussion. Iowa Insurance Commissioner, Doug Ommen discussed some alternatives at that meeting. The Democratic legislators suggested some additional options.

The second public meeting is scheduled this week:

Wednesday, June 21st, 6-8 pm

Des Moines Public Library, 1000 Grand Ave.

Iowa Senator Matt McCoy, Representative John Forbes and former Senator Jack Hatch will continue the discussions about solutions to the Iowa Health Care Crisis at this meeting. They have invited other legislators and the Iowa Insurance Commissioner Doug Ommen.

The options discussed at the first meeting included:

Iowa Health and Human Services could require the current Medicaid Insurance carriers (MCOs) to sell plans on the Iowa Exchange. Nevada requires its Medicaid MCOs to sell on their Exchange.

On January, 1, 2017, the Feds offered a new state option within the Affordable Care Act (ACA). It is known as Section 1332 Waiver. Ommen explained these require federal approval. These 1332 Waiver options offer states an opportunity to design new coverage options customized for each state under the ACA. It requires states to pass authorizing legislation.

Another proposal would allow some customizing of Medicaid funding. The suggestion would allow some of those individuals (based on income) currently on the exchange the option of buying into Medicaid.

Since the first meeting, Doug Ommen and representatives of Wellmark and Medica met with President Donald Trump’s health-care administrator in Washington, D.C. to discuss options. Ommen’s solution would require federal money and federal approval.

Ommen’s suggestion uses current Obamacare money to subsidize health-insurance premiums. His proposal would increase amounts to help young adults and reduce help to older adults. The goal is to get more young, healthy people into the program.

“Our proposal is to have a market versus not to have a market,” Ommen said.

Currently, Iowans on the exchange receive $194 million in subsidies and $48 million in cost-sharing reduction payments in 2017. These cost-sharing payments going to insurers are meant to assist low income customers with out-of-pocket co-payments and deductibles. Under the stop-gap plan that money would be diverted.

In addition, Ommen is asking the Federal Government for $80 million to cover a reinsurance program. “The reinsurance program is…designed to protect insurers against risks of customers coming down with a range of expensive health conditions,” he said.

It appears that this reinsurance program might meet the demands of some of those insurers that pulled out of the market for 2018. They might resume offering plans on the exchange utilizing this assistance for high risk customers.

A Wellmark spokesmen said, “If it is approved in a reasonable timeframe, Wellmark will re-enter the individual health insurance market in all 99 Iowa counties in 2018. We are pleased to work alongside Commissioner Ommen to create an innovative, Iowa-based solution.”

The big unknown is the shape of the Republicans’ American Health Care Act proposal. Since the Senate Republicans are designing this in secrecy, one can only guess what the final bill may look like and how it might change the design of the current exchanges. Even if Ommen gets approval for his plan, Republicans still might blow up the structure of the exchanges.

This discussion isn’t over and Democrats intend to have some additional input. This is an opportunity to make major changes including some type of public option. Nationwide, Democrats are coalescing around a Medicare-For-All approach and this could be the first step in that direction.

by Rick Smith

Posted 6/19/17