BY CHUCK VANDENBERG
FORT MADISON – Iowa’s Insurance Division, headed by Doug Ommen, has proposed a stopgap measure to the Centers for Medicare & Medicaid Services (CMS) to ensure all Iowans have access to health insurance in 2018.
According to a press release from the division, Iowa will not, in all likelihood, have a participating market provider in 2018 under the current health insurance marketplace structure, a move that some estimate will effect 72,000 Iowans. The proposal would use federal tax credits, reinsurance, and high-risk pools to offer a more favorable environment to providers, while keeping premiums and tax credits at rates comparable to Affordable Care Act plans.
Tony Wolfe, of Tony Wolfe Insurance Services in Fort Madison, said the proposal would likely get massaged a little if it gets approved.
“My view is that it was expected there would be some type of solution offered and we should assume adjustments and tweaking to whatever is proposed will likely occur,” Wolfe said. “That said, there are a broad range of changes in requirements and steps that health insurers, providers, advisors, members, and everyone else relative to this industry have made in recent years. We need to be patient and cautiously optimistic a system will be found that results more favorably than what is currently in place. It is important to take care of people’s needs while we make this necessary change.”
Federal poverty lines for a family of three for 2017 is $20,420 up $260 from 2016 numbers.
Under the proposed rate structure, which starts credits at 133% of poverty level (anything less than 133% would ultimately fall under the state’s medicaid/medicare program) an individual 0-20 years old would be entitled to a $250 credit and have a monthly premium of $22. Two adults ages 35-44 at the same (making up the family of three) would be entitled to a $398 credit and face a $56 premium per person per month. That family of three under the current proposal would pay $134 a month for their family coverage.
“We’re clearly supportive of the efforts led by our insurance commissioner, Doug Ommen, in partnership with the executive teams at Wellmark and Medica. Given the dire situation facing many Iowans in 2018, these leaders are doing what it is going to take to put some short-term stability back in the market,” said Justin Pieper, co-founder of Fort Madison’s Group Benefit Partners.
Pieper said the real decisions lie in the hands of Secretary of Health and Human Services Tom Price and Seema Verma, a top health adviser to President Donald Trump in Washington D.C., but leaders have been having productive meetings discussing what could work in Iowa. The next steps could likely include town hall meetings, where feedback will be solicited.
Another hurdle facing the proposal would be getting a computerized exchange up and running, even though it is likely that only one standard plan comparable to the ACA’s Silver plan would be offered to Iowans.
Peiper said he would encourage participating in these meetings in support of the proposed actions, as this will need to come together quickly, in order for the insurance companies to establish the products and pricing in time for a January 1, 2018 release.
“We also encourage dialogue with our elected officials in Washington D.C. so they understand how important it is to Iowans that these measures are solidified. While these are necessary measures in the immediate short-term, a long-term fix is absolutely necessary for continued improvements in the market conditions.”
Wellmark Chairman and CEO John Forsythe indicated Wellmark’s support of the initiative.
“Wellmark is supportive of the proposed Stopgap Measure submitted to CMS because it includes the three principles we have continuously advocated for: creation of a viable risk pool, sharing catastrophic expenses, and product flexibility. If the measure is approved in a timely manner with these principles intact, Wellmark will offer the approved individual health insurance plan in all 99 counties in Iowa for 2018.”
In a statement Monday, Wellmark indicated it had publicly shared its desire to structure an Iowa-based solution that makes the individual market stable and affordable again, including maintaining several key aspects of the Affordable Care Act (ACA) combined with three principles: ensuring a viable risk pool, broadly sharing catastrophic costs, and the flexibility to design plans Iowans want and can afford.
Existing ACA plans will be in effect through Dec. 31, 2017. During Open Enrollment this fall, members will need to enroll in a new plan for coverage in 2018.
Other providers in 2017, including Medica and Aetna are still reviewing the proposal, but have been engaged in the development of the proposal.