Iowa health insurance
A look at health and the Affordable Care Act in 'The Hawkeye State'
By Carla Anderson
August 18, 2014
Comparing the states is a national pastime – whether the category is just for fun or more serious. This brief summary compares Iowa to the rest of the states in terms of health status, uninsured rates, and approach to health care reform.
Iowa health ratings
Iowa rounds out the top 10 in the Commonwealth Fund’s 2014 Scorecard on State Health System Performance, which evaluates the 50 states’ and the District of Columbia’s performance on more than 40 health measures. Iowa’s overall health ranking fell two positions since 2009. Review Iowa’s Scorecard.
America’s Health Rankings look at a somewhat different set of measures, and Iowa is No. 18 in this evaluation. Iowa scores well for its high high-school graduation rate and the low percentage of children living in poverty. Public health challenges in Iowa include a high prevalence of obesity and binge drinking and limited availability of primary care doctors.
Another source for public health information is the 2014 edition of Trust for America’s Health; see Key Health Data About Iowa.
Finally, you can zoom in and get county-by-county health rankings for Iowa from the Robert Wood Johnson Foundation and the Population Health Institute at the University of Wisconsin.
Iowa and the Affordable Care Act
Iowa Sen. Thomas Harkin (D) voted yes and Sen. Charles Grassley (R) voted no when the Affordable Care Act was passed in 2010. Both senators remain in office; however, Harkin is retiring and not running for re-election in November 2014.
Grassley proposed an amendment to require members of Congress and their staffs to use the health insurance marketplace – even though the marketplace was intended for individuals and small businesses. Confusion over the amendment led to charges that Congress was exempting itself from Obamacare.
Three Iowa House members – all Democrats – voted in favor of the ACA, while two Republicans voted against it. Iowa has since lost a seat in the House through the reapportionment process, and its four remaining representatives are evenly split between the Democratic and Republican parties.
Within the Iowa legislature, Democrats hold a slim majority in the Senate, and Republicans control the House.
Gov. Terry Branstad is a Republican and not supportive of the Affordable Care Act. In 2011, Branstad signed Iowa onto Florida’s lawsuit challenging the ACA.
Branstad stated a preference for a state-based insurance marketplace, but said the federal government had not provided enough information for Iowa to proceed with that option. Iowa currently operates a partnership marketplace.
The federal government approved two Iowa waiver applications to expand Medicaid under the ACA. One waiver is the so-called “private option.” Medicaid funding is used to pay for the purchase of private health insurance through the marketplace for residents with incomes between 100 and 138 percent of the federal poverty level (FPL). The other waiver expands Iowa’s current Medicaid program, which is called the Iowa Wellness Plan, to nonelderly adults with incomes up to 100 percent of FPL.
The ACA’s impact in Iowa
Seventy-one percent of Iowa’s 301,000 nonelderly uninsured residents qualify for either Medicaid or tax subsidies to help pay for coverage purchased through the marketplace.
Iowa, along with Kansas and Virginia, saw an increase in its uninsured rate between 2013 and mid-2014. Iowa’s rate increased 0.6 points – from 9.7 percent to 10.3 percent. Nationally, the uninsured rate dropped 4.6 points to 13.4 percent between 2013 and mid-2014.
Iowa enrollment in QHPs
About 29,000 Iowans of an estimated market of 262,000 eligible residents enrolled in a qualified health plan (QHP) during the 2014 open enrollment period. That’s just 11.1 percent, below the national average of 28.0 percent.
Among Iowa residents who signed up for a QHP, 84 percent qualified for tax subsidies to help offset the premium cost.
Forty-seven percent of Iowa’s 301,000 nonelderly uninsured residents qualify for Medicaid or the Children’s Health Insurance Program (CHIP), according to the Kaiser Family Foundation.
Learn about Iowa’s Medicaid program.
Other ACA reform provisions
The ACA’s Consumer Operated and Oriented Plan (CO-OP) Program encourages the creation of nonprofit, consumer-run health insurance issuers. Twenty-four CO-OPs received loans totaling $1.98 billion as of January 2013. CoOpertunity Health, which operates in Iowa and Nebraska, received $112.6 million. See where CO-OPs were launched.
Does Iowa have a high-risk pool?
Before the ACA reformed the individual health insurance market, coverage was underwritten in nearly every state, including Iowa. Applicants with pre-existing conditions were often unable to purchase private coverage, or found themselves with very limited options that didn’t cover their pre-existing conditions.
The Iowa Comprehensive Health Association (otherwise known as Health Insurance Plan of Iowa, or HIPIOWA) was established in 1987 to give people an alternative if they weren’t eligible to buy private plans because of their medical history.
Under the ACA, all new health insurance policies became guaranteed issue starting on January 1, 2014. As a result of this reform provision, there is no longer a pressing need for high risk pools. HIPIOWA is still operational however, and had 3,002 members as of the end of December, 2013. At a board meeting in January, 2014, there was discussion about the need to inform members of their options under the ACA, and the fact that legislation would be needed for HIPIOWA to cease operations. At that same board meeting, it was noted that a large number of members had terminated their coverage in January, likely because they had found a better option in the newly guaranteed-issue individual market. But four new applications for HIPIOWA coverage had been received in January, and there are no immediate plans to terminate coverage.
Iowa’s state-based reform legislation
Here’s what’s happening legislatively in Iowa with healthcare reform at the state level: