It’s less than two weeks until people have to start signing up for next year’s health insurance plans, and Iowans who buy their own insurance through the Affordable Care Act don’t know what to expect. They don’t know what system they will use to buy insurance, what plans will be available to them, or how much they will have to pay.
Iowa is waiting for a last-minute decision from federal agencies on whether Iowans will buy insurance through the ACA marketplace, or through the state’s proposed "stopgap" system.
In the meantime, Marion resident Jaci Ampulski says she doesn’t know what her health insurance options are, or how much they might cost. She says she’s worried.
"If I don’t know about it and I work in health care billing, I don’t know how anybody else is going to have any idea what’s going on," Ampulski says.
Ampulski says other than what she has read in newspapers, the only information she got was an email from her insurance carrier saying her plan was being canceled. Thousands of Iowans got a similar notification because only one insurance company, Medica, will offer health plans on the state’s ACA marketplace in 2018.
Karen Sullivan of Visiting Nurse Services in central Iowa runs a program that helps people sign up for insurance through the ACA. She says consumers are confused.
"They’re not certain what’s happening to the ACA because there’s been so much publicity in the news about Congress trying to make changes to the ACA," Sullivan says. "So many people are concerned, is it or is it not around? And what do I do to get insurance for myself and my family?"
Sullivan says most people who call in don’t know about the "stopgap" measure that Iowa has proposed to stabilize its individual insurance market.
"It’s going to be a very tight timeline, and I’m concerned that the word’s not going to get out quick enough as to how people should enroll in health insurance," Sullivan says.
The state of Iowa is still waiting for federal approval of its plan to change how Obamacare subsidies are distributed to people who buy their own insurance.
"If we don’t get word by the end of this week, clearly we’re running—we’ve run out of time," says Iowa Insurance Commissioner Doug Ommen.
He says the state has been testing its sign-up system for the stopgap plan and will be ready to start enrollment on Nov. 1 if the plan is approved. The real issue will be having enough time to educate Iowans on how to buy insurance before the sign-up period ends on Dec. 15.
"I am concerned about those that are currently in the Aetna population because it really does require a significant effort to reach out to those individuals," Ommen says.
The majority of people who have insurance on the ACA exchange get plans from Aetna, which will not offer individual plans in Iowa next year.
But Ommen says it’s more important to reach healthy, young people who have stopped buying insurance in recent years. He says including them in the market will spread the risk, which would slow down price increases.
Health policy experts say there is not enough time to educate 70,000 people about a brand new way to sign up for insurance.
Whether Iowans will be better off with the stopgap plan depends on an individual’s income level and health.
The stopgap plan redistributes ACA funding so everyone who buys insurance will get financial assistance. People with middle and high incomes will get extra help paying their insurance premiums. But these health plans will have a deductible of $7,350 for a single person, and twice that for a family. Sick people with modest incomes may struggle to pay these higher out-of-pocket costs.
"Yes, some individuals will have a more challenging experience, and some people will have a better experience," Ommen says. "But a commercial market can’t work unless it’s attractive to healthy people."
This is a major reason why left-leaning groups and advocacy organizations for people with cancer and diabetes have criticized the stopgap plan. They say this plan does not fit the legal requirement of providing coverage that is at least as affordable as it would be under the ACA. And some critics expect the plan to add to the federal deficit, which also goes against the rules of obtaining a State Innovation Waiver.
Iowa requested "emergency relief" from some of these rules because it’s a short term plan, and because the Trump administration encouraged states to propose changes to their ACA markets. Still, Ommen says the process has been "a real challenge".
Federal officials were concerned about the plan’s lack of funds to help cover copays and deductibles for low-income people. A recent change to the plan added cost-sharing for most of the people who qualify for those subsidies under the ACA.
Gov. Kim Reynolds discussed the stopgap plan Wednesday during a phone call with President Trump.
"So we agreed on this: the understanding that there needs to be possibly some kind of a short term fix," Reynolds says. "He’s not signing off on anything."
Reynolds says she and Trump agree the ACA should be repealed and replaced.
Ultimately, it’s the secretary of health and human services and the secretary of the treasury that have to sign off on the plan.
If the stopgap isn’t approved, people who have ACA plans will be automatically enrolled in a Medica plan. For people at middle and higher income levels, it means they might have to pay double or triple what they paid this year for health insurance.
While the state waits for a decision from the feds, Iowans have little information with which to make hard decisions of their own.
"I don’t have to live in Iowa," Ampulski says. "And if this continues to be such a big issue, I’ll move out of state in order to have affordable health care if that’s what I have to do."