Tag Archive: Iowa

Iowa files urgent ACA 1332 waiver request to preserve 2018 non-group market

Facing the prospect of no health plan issuers offering coverage in the individual, non-group medical insurance market in 2018, Iowa is urgently asking the federal government for a state innovation waiver under Section 1332 of the Patient Protection and Affordable Care Act. The proposed stopgap measure by the state’s Insurance Division requests federal premium and cost sharing subsidies be used to fund the Proposed Stopgap Measure (“PSM”) Plan. The plan would offer a single standardized benefit plan with an actuarial value of 68 to 72 percent with premium subsidies determined by age and household income. It also proposes the federal Affordable Care Act funding support a reinsurance program for individuals incurring medical expenses greater than $100,000.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Iowa may be first state with no health insurers on exchange – SFGate

DES MOINES, Iowa (AP) — Iowa could be the first state in the nation with no health insurance company willing to offer policies on its Affordable Care Act exchange next year unless President Donald Trump’s administration approves a stopgap proposal, Iowa Insurance Commissioner Doug Ommen said Monday.Ommen said he and officials from two major Iowa insurance carriers met last week with Centers for Medicare & Medicaid Services officials in Washington to pitch a proposal that would save the Iowa market from collapsing.Several counties in Missouri, Ohio and Washington state have no insurer for next year, but Iowa would be the first state to lose all insurers on an ACA exchange.

Source: Iowa may be first state with no health insurers on exchange – SFGate

The dreaded adverse selection death spiral appears to have gained a grip on Iowa’s non-group medical insurance market. The item reports Iowa Insurance Commissioner Doug Ommen is asking the federal government to redirect advance premium tax credit subsidies to improve the spread of risk in the state’s pool by attracting more younger individuals and using some of the those dollars to cover higher cost people.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Iowa governor exploring interstate health benefit exchange with 3 adjacent states

Iowa Governor Terry Branstad wants to confer with governors of three neighboring states about setting up an interstate health benefit exchange marketplace. Iowa and the other states –South Dakota, Nebraska and Kansas — have opted to have the U.S. Department of Health and Human Services initially operate their exchanges.

Branstad reportedly cited the fiscal benefit of sharing exchange operating costs and the presence of Iowa health plan issuers Wellmark Blue Cross and Blue Shield and CoOportunity Health in the other three nearby states.

Section 1311(f) of the Patient Protection and Affordable Care Act authorizes the operation of “Regional or Other Interstate Exchanges” operating in more than one state, subject to the approval of the involved states and the federal Department of Health and Human Services.

The Quad City Times has the full story here.

See also this analysis of Affordable Care Act provisions that would enable less populous states like Iowa to join with other states to form larger pools of potential individual enrollees, generating better spread of risk for health plans and increasing the purchasing power of exchange member states with plan issuers.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Some states expanding Medicaid eligibility through exchange marketplace

Some states that initially decided not to expand Medicaid eligibility guidelines for individuals earning up to 133 percent of federal poverty guidelines as permitted under the Patient Protection and Affordable Care Act are now opting to do so. But instead of directly expanding their existing Medicaid programs, the states want to integrate broadened Medicaid eligibility into their health benefit exchange marketplaces. And they want to do so with some economic incentives for enrollees.

The Washington Post’s Wonkblog reports Iowa joins Arkansas in obtaining a waiver from the U.S. Department of Health and Human Services to use federal dollars funding the Medicaid expansion to subsidize the premiums for commercial plans sold on the exchange marketplace. Iowa’s Marketplace Choice includes a wellness component that waives plan premiums for plan years 2014-16 if participants undergo annual health screenings and follow a doctor-directed wellness regimen.

On December 6, 2013, Pennsylvania submitted its waiver application to the federal government. The Keystone State’s proposed 5-year Healthy Pennsylvania program that would similarly allow those age 21 to 65 earning up to 133 percent of federal poverty to purchase commercial coverage on that state’s exchange. Enrollees earning 50 percent of federal poverty and greater would pay modest premiums that could be reduced with incentives for healthy behaviors and engaging in ongoing work search activities.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Iowa, South Dakota Blues Skip Obamacare Exchange Next Year – Capsules – The KHN Blog

The fewer insurers that sell through exchanges, the less competition there will be for customers through price and service. Many insurers are approaching the exchanges cautiously because of concerns that the technology may not be ready and that the first customers will be disproportionately sick and expensive, analysts say.

via Iowa, South Dakota Blues Skip Obamacare Exchange Next Year – Capsules – The KHN Blog.

This is the key paragraph of the story relative to its implications for these and other state exchanges next year, particularly in smaller states where the absence of a major plan issuer can adversely affect the ability of the exchanges to attract individuals and small employers.

Participation in the exchange marketplace is voluntary for sellers and buyers.  But it won’t function as intended to make coverage more affordable and of better value unless it can generate sufficient economies of scale from both sides of the market.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Credit unions partner with COOP plan in two Midwestern states

In two Midwestern states with a tradition of consumer cooperatives, credit unions will help enroll members in an Iowa-based consumer operated and oriented (CO-OP) health plan, CoOportunity Health, that will offer plans on the states’ health benefit exchange marketplaces. According to the CreditUnionTimes, CoOportunity Health will offer coverage in Iowa, which will operate a state partnership exchange with the federal government, and Nebraska, which has opted for a federally operated exchange. Group Benefits Ltd. will serve as the preferred broker, according to the story.

This is a noteworthy development because it shows interstate cooperation and the innovative use of an established and trusted distribution channel to drive enrollment in the exchange marketplace. It could also serve as a template for health plans to market across state lines via “health care choice compacts” starting in January, 2016 as authorized by Section 1333(a) of the Affordable Care Act. (The ACA specifies implementing regulations be issued by July 1, 2013, but the rules have not yet been promulgated). It could also pave the way for state exchanges to combine into “regional or other interstate exchanges” subject to approval by the participating states and the federal Department of Health and Human Services under ACA Section 1311(f).

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Iowa would fully subsidize newly eligible Medicaid beneficiaries for exchange plans

According to the story at the KCRG-TV9 website, under the Iowa Health and Wellness Plan devised by state policymakers, Iowans eligible for expanded Medicaid coverage under the Patient Protection and Affordable Care Act with incomes between 101 and 138 percent of federal poverty levels would purchase private coverage sold on Iowa’s health benefit exchange. Iowa is one of several states that have opted to run its exchange in partnership with the federal government.

For this population, there would be a caveat attached to their premium subsidies. They would have to undergo yearly health screenings and follow a doctor-directed wellness regimen.  Beneficiaries that comply would have their premiums fully subsidized under the Medicaid expansion.  Those who do not would have to pay a share of their future premium costs as contemplated under the Affordable Care Act’s advance tax credit subsidies based on household income.  The novel plan would require a waiver from the federal government’s Center for Medicare and Medicaid Services (CMS).

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

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