Federal administrators are still not ready to make a decision on Iowa’s “stopgap” proposal to shore up the state’s shaky market for individual health insurance, less than two weeks before 2018 sign-ups are to begin.

The Centers for Medicare and Medicaid Services sent a letter Thursday to Iowa Insurance Commissioner Doug Ommen, saying the federal agency was still trying to decide whether to approve the proposal. Thursday was the deadline for public comment on the controversial idea, which would reroute federal health insurance subsidies provided by the Affordable Care Act. State officials had hoped for a quick answer because they would need time to implement substantial changes to Iowa's insurance market before the six-week open-enrollment period starts Nov. 1. Among other things, they would have to take responsibility for online sign-ups, which are now handled by the federal marketplace, healthcare.gov.

Randy Pate, a top administrator for the federal agency, wrote in his letter to Iowa that his office was still working to determine if the stopgap proposal would meet all regulations under the Affordable Care Act. One of the key questions is whether it could be funded without increasing costs to the federal government, he wrote. “We look forward to working with you on your application and will be in touch if we need additional information,” he wrote. He gave no indication of how long that might take.

Ommen told Iowa Public Radio on Tuesday that he needed an answer from federal officials by the end of this week. But Ommen's spokesman, Chance McElhaney, told the Register on Friday afternoon that the division was still in talks with their federal counterparts. He would not elaborate.

The stopgap plan would affect about 72,000 Iowanswho buy their own health insurance instead of obtaining it via an employer or a government program, such as Medicare or Medicaid.

Glen Gardner of Cedar Rapids is among those 72,000. He voiced frustration Friday after learning federal administrators told Iowa counterparts only that they would get back to them. "When?" Gardner said. "We're running out of 'we'll get back to you' time."

Gardner and his wife qualify for federal subsidies to help pay their premiums. But they haven't received any official information about their options since June, when their current carrier, Aetna, informed them it would pull out of Iowa's individual insurance market at the end of December. Gardner said Friday he couldn't begin to predict what the couple would do for insurance for 2018. "I've given up guessing," he said. "I have no information on which to base an intelligent decision."

The Washington Post reported Oct. 5 that President Trump personally ordered federal administrators to block the Iowa plan in August. Trump is a staunch opponent of the Affordable Care Act, and he has said Republicans should let it implode. The Post story, which cited anonymous sources, did not say how the administrators reacted to his demand to reject Iowa's proposal. Federal officials have been saying publicly they continue to consider the proposal, but they're taking much longer to make a decision than state officials had hoped.

Ommen proposed the plan in June. He says it would stabilize the market by encouraging more young and healthy people to buy insurance. The plan also would help insurance carriers shoulder the cost of members who use more than $100,000 worth of health care in a year.

Without the stopgap plan, just one carrier, Medica, intends to sell individual insurance policies in Iowa next year. It intends to raise premiums by an average of more than 57 percent. Many consumers would be sheltered from those increases because they qualify for Affordable Care Act subsidies that would rise to cover the higher costs. But Iowans who make too much money to qualify for those subsidies would have to pay the whole amount. Ommen has predicted that more than 20,000 of them would drop their coverage instead. His proposal would offer subsidies to thousands of Iowans who don't now qualify.

Iowa's largest overall health-insurer, Wellmark Blue Cross & Blue Shield, has pledged to resume selling individual policies if the stopgap plan is approved. Ommen has said the plan would lead to dramatically lower premiums. However, critics have predicted it would spark a legal challenge, because it would reduce a type of subsidy that helps reduce deductibles and co-pays for moderate-income Iowans.

Sign-ups for 2018 individual coverage are to begin Nov. 1. The open-enrollment period, which has been three months long in past years, was cut to six weeks by the Trump administration.

Janis Van Ahn, a Johnston insurance broker specializing in health coverage, said Iowa could wait right up until the end of October and try to switch to the stopgap insurance plan on Nov. 1. But she worries about a replay of Obamacare's launch in the fall of 2013, when the federal government's healthcare.gov website repeatedly crashed, leaving consumers and brokers scrambling. In that case, the open-enrollment period lasted more than four months, giving officials time to patch up the website, she noted. "This time, we have 45 days," she said.

On the same day federal officials sent Iowa this week's no-decision letter, they notified Oregon that its waiver proposal had been approved. A spokeswoman for the federal agency declined to comment on the matter, beyond saying there had been no change in the status of Iowa's application.

Iowa's governor and U.S. senators, who are all Republicans, have urged the Trump administration to approve the state's stopgap proposal. Sen. Joni Ernst's spokeswoman, Leigh Claffey, said Friday that Ernst continued to hope it would be approved by the federal agency. "Given the situation with our health insurance market in Iowa due to the failures of Obamacare, Sen. Ernst will continue urging CMS to take up this proposal as soon as possible," she wrote in an email to the Register. Sen. Chuck Grassley's office also expressed continuing hopes for the plan.

Ernst and Grassley have signed on as co-sponsors of a bipartisan proposal, known as the Alexander-Murray bill, to try to shore up health-insurance markets. Among other things, the bill aims to make it easier for states to apply for waivers to Affordable Care Act rules. However, some national experts doubt the bill could be implemented quickly enough to affect coverage for 2018.