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Iowa health insurance exchange / marketplace

Subsidies on the line for 33k in King case, but many new plan options coming to the exchange in 2016

King v. Burwell – subsidies on the line for 33k

In states that use the federally-facilitated marketplace (FFM) – like Iowa – the availability of subsidies hinges on the outcome of the King v. Burwell lawsuit.  The Supreme Court is expected to issue a ruling later this month, and if subsidies evaporate in FFM states, 33,000 people in Iowa would lose their subsidies – and likely their insurance, since it would become unaffordable without subsidies.  The American Academy of Actuaries has estimated the premiums across the entire individual market in FFM states would also increase by about 35 percent if subsidies are eliminated, so the financial pinch would also be felt by people who aren’t eligible for subsidies.

looking ahead to 2016

The Iowa Insurance Division announced in May that five carriers had submitted proposals to sell individual coverage in the exchange for 2016 – up from three that currently offer plans.  Coventry and Medica will offer plans state-wide, while the rest of the carriers will have plans in select areas.  United Healthcare of the Midlands, Avera, and Gunderson will all offer plans in various areas of the state, and two additional carriers will offer small group plans through the exchange.

The added competition and plan choice will be a welcome change for Iowans, who currently have just one carrier (Coventry) in their exchange.  Open enrollment for 2016 begins on November 1, with coverage effective January 1, 2016.

News of rate increases for Iowa made headlines in early June, but the most significant rate hikes were proposed by Wellmark, which only sells coverage outside the exchange.

2015 enrollment

More than 45,000 Iowans singed up for qualified health plans during the second open enrollment period. While an improvement on the 2014, the 2015 total is just 20 percent of the estimated 225,000 Iowans who are eligible to sign up on Nationally, about 40 percent of those eligible actually enrolled during the 2015 open enrollment period.

 Co-op plan folds

Only one insurer – Coventry – currently offers individual plans in the Iowa marketplace.  Wellmark, the largest insurance carrier in Iowa, did not participate in the marketplace in 2014 and decided against joining the exchange for the 2015 and 2016 plans years.

A second insurer, CoOportunity Health, had been participating in the marketplace, but stopped offering policies in late December 2014. CoOportunity was a start-up health insurer formed with funding through the Affordable Care Act. The insurer got into financial difficulty after higher than expected enrollment and claim costs in 2014.

Nick Gerhart, the Iowa insurance commissioner, assumed oversight of CoOportunity and determined that the insurer had to be liquidated.  With CoOportunity’s withdrawal, Coventry is the only marketplace insurer available in Iowa – but that will change in 2016.

Premiums up 11 percent on average

A study by The Commonwealth Fund shows that 2015 marketplace premiums in Iowa are up 11 percent on average compared to 2014. The Commonwealth Fund’s study was weighted for differences in premiums between urban/suburban/ rural areas and insurer participation.

2014 enrollment metrics

In total, 29,163 people enrolled in qualified health plans (QHPs) during 2014 open enrollment, and an additional 36,891 people qualified for Medicaid or the Children’s Health Insurance Program (CHIP).

Just 11.1 percent of Iowa residents eligible to enroll through the marketplace did so in 2014. Iowa tied with neighboring South Dakota for the lowest percentage of eligible enrollees signing up. A Kaiser Health News article attributes the low enrollment in both states to Wellmark Blue Cross & Blue Shield’s decision against participating in the states’ marketplaces rather than a boycott of the Affordable Care Act.

A U.S. Department of Health and Human Services report showed the 2014 average, post-subsidy premium for Iowa consumers was $108 per month. The national average in states using $82 per month after subsidies.

Twenty-six percent of Iowa residents selected a bronze plan (20 percent nationally), 57 percent selected a silver plan (65 percent nationally), 12 percent selected a gold plan (9 percent nationally), 4 percent selected a platinum plan (5 percent nationally) and 2 percent selected a catastrophic plan (2 percent nationally). Twenty-six percent of Iowa enrollees were between the ages of 18 and 34.

Iowa’s uninsured rate decreased 1.4 points, from 9.7 percent in 2013 to 8.3 percent in 2014 according to the Gallup-Healthways Well-being Index.

Iowa’s approach to the marketplace

Iowa operates a partnership exchange with the federal government. Iowa residents use the federal marketplace,, to compare and purchase coverage. The state is responsible for plan management, consumer assistance, and Medicaid eligibility determination. Iowa’s plan management functions include selecting and monitoring the qualified health plans (QHP) that offer policies on the exchange. Iowa’s role in consumer assistance is education and outreach, coordinating the in-person consumer assisters, and overseeing the Navigator program. The federal government manages the exchange website and call center, and funds the Navigator program.

Iowa is occasionally mentioned as a state that may transition to a different model for its exchange. In February 2014, Gov. Branstad floated the idea of a regional exchange in conjunction with South Dakota, Nebraska and Kansas. Bills to convert to a state-run exchange were introduced in Senate committees in both 2013 and 2014, but neither advanced.

Iowa health insurance exchange links

Iowa Insurance Division: State Partnership Exchange Plan Management

State Exchange Profile: Iowa
The Henry J. Kaiser Family Foundation overview of Iowa’s progress toward creating a state health insurance exchange.

Consumer Advocate Bureau
Provides consumers with assistance in navigating the health care system, assistance programs, and other issues related to health insurance benefits.
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