Which Insurers Will Remain On Iowa’s Exchange?

DES MOINES -- After Monday's announcement that Wellmark Blue Cross and Blue Shield no longer will sell individual policies on or off the Iowa exchange, two of the three remaining insurers are cautious to reveal their future plans.

Wellmark's decision - which will affect about 21,400 Iowans - was made due to high costs and uncertainty over the future of the Affordable Care Act. The Des Moines-based insurer, which has sold plans off the exchange for three years and on the exchange for one, has lost about $90 million through the individual market.

This change does not impact the 76,600 people who purchased individual or family health plan pre-ACA - before Jan. 1, 2014 - through Wellmark. It also does not impact members with plans through their employer, including small group ACA plans, or those with Medicare supplement plans.

The problem Wellmark and other insurers are facing is that not enough young and healthy people are choosing to enroll in plans to help spread out costs. Instead, older, sicker individuals with multiple chronic illnesses - who need insurance and coverage - are purchasing the health plans, putting a high concentration of expenses in the individual market.

The remaining insurers selling plans on the Iowa exchange include Medica, Aetna and Gundersen Health Plan.

"We are still developing our 2018 strategy and have not yet made final decisions," said Greg Bury, a Medica spokesman. "In light of information about insurers pulling their products from the individual market in Iowa, Medica needs to carefully consider its options."

The Minnesota-based insurer has about 14,000 Iowa members, Bury said.

Aetna, which has sold plans in the state since 2014, said on Tuesday that its position remains the same as it did in January of this year - it will not enter into any new ACA markets in 2018 and will continue to evaluate the states where it has a presence.

Wellmark isn't the first company to withdrawal from the state - UnitedHealth Group, which sold health plans on the Iowa marketplace for one year, announced in April 2016 that it would pull out of 30 states, including Iowa. In December of 2014, not-for-profit insurer CoOportunity Health was taken over by the state after it had too many members for its financial reserves.

According to an analysis by Kaiser Family Foundation, 13 of Iowa's 99 counties only had one insurance option during the 2017 open enrollment season; 50 counties had two options and 36 counties had three options.

Insurers have until mid-June to decide if they will sell ACA plans on and off the marketplace.

"We're disappointed in the developments," Iowa Insurance Commissioner Doug Ommen said. "When you lose options, you lose choice in providers.

"None of that is good, whether you're young and starting a business or a family or you're in your middle years and want to make sure you can take care of issues that arise. No one want to be in position of being stressed or without any options."

Ommen said he is waiting to see how the marketplace shakes out once the filing deadline has passed. But the insurance division wants to find long-term solutions and ways to "relieve individual market pressures" insurers may feel.

"There are a fair numbers of conversations occurring to bring stability to market," he said. Insurers "are looking for stability and predictability going forward, and we are heavily engaged in conversations."

However, he said the state's ability to do so is somewhat limited as the passage of the ACA transferred power to the federal level.

"Before the ACA, Iowa had some of the lowest uninsured rates in the country," he said. "We are a state that has been historically able to address concerns as presented. ... We have urged our delegation, along with the governor and lieutenant governor, to return responsibility back to the state."