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Neighbors Growing Together | Oct 18, 2017

Trump administration pushes Iowa’s Obamacare alternative forward

Sep 20, 2017

By Ed Tibbetts, Quad-City Times

 

The Trump administration has taken a step toward final approval of a stopgap measure in Iowa to stabilize the state’s individual insurance market, officials said Tuesday.

The proposal would dramatically alter how the Affordable Care Act is carried out in the state.

The Iowa Insurance Division announced Tuesday the administration has issued a “letter of completeness” in response to its request to waive several provisions of the ACA, also known as Obamacare. The letter kicks off a 30-day comment period.

“We appreciate the Trump administration’s commitment to state flexibility and providing relief from the ACA,” Iowa Insurance Commissioner Doug Ommen said in a statement. “We look forward to swift approval by the administration after the federal comment period closes so the Iowa Stopgap Measure can be ready for the 2018 open enrollment period starting November 1, 2017.”

The insurance division said in June it was proposing the plan in response to the possibility that no insurer would be willing to sell policies on the individual insurance market in Iowa in 2018. That would put 70,000 Iowans at risk, it said.

The state’s proposal was formally presented to the administration in August.

After the initial announcement, Minnesota-based Medica said it would re-enter the marketplace but only at markedly higher premiums than this year.

State officials have continued to push for the stopgap measure, however. They say that without it, 22,000 Iowans would leave the individual marketplace.

The administration’s letter, which was sent Tuesday from Randy Pate, deputy administrator at the federal Centers for Medicare and Medicaid Services, says a preliminary examination of the proposal has been conducted and comments will be taken through Oct. 19.

A final decision would be made within six months of that date, the letter said. However, Ommen said Tuesday the state expects a decision by Nov. 1. He said the division is in “regular communication” with the Trump administration.

The state insurance division also said Wellmark Blue Cross & Blue Shield and Medica have submitted rate proposals to offer plans through the stopgap proposal that are significantly lower than what would occur under the ACA.

The stopgap proposal would establish a single, standardized plan that each carrier would offer. In addition, premium tax credits under the ACA would be restructured and a reinsurance program utilizing ACA funds would be established to handle high-cost patients. The tax credits, which would be based on age and income, would be available to all Iowans in the individual market, regardless of income. Currently, the ACA cuts off the tax assistance to those making more than 400 percent of the poverty level.

Since the major provisions of the Affordable Care Act have kicked in, the state’s uninsured rate has shrunk by about half, according to Census Bureau estimates. But those who don’t buy insurance on the individual market or don’t qualify for tax credits have seen premiums increase substantially.

Since the state’s proposal, some analysts have questioned whether the Trump administration can grant a waiver under the law, which has certain requirements. Among the questions is whether the stopgap measure will meet the law’s requirement that a comparable number of people continue to be covered and that protections against excessive out-of-pocket expenses would be comparable to what they are under existing law. The state’s proposal says it meets the affordability and availability requirements for an ACA waiver.

The insurance division says that comments should be submitted to CMS Administrator Seema Verma and Center for Consumer Information & Insurance Oversight (CCIIO) Director Randy Pate by email at StateInnovationWaivers@cms.hhs.gov and should include “Iowa Section 1332 Waiver Comments” in the subject heading. Commenters should include their name, organization (if any) and email address with the comments.

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