So what, exactly, is the matter with Iowa?
The state’s individual market faces several major problems. The first is that, to a large extent, it did not actually implement Obamacare. Nationwide, nearly all people who bought their insurance on the individual market are enrolled in plans that meet certain Obamacare requirements. For example, these govern what health benefits must be covered, how much patients can be forced to spend out of pocket, and whether or how much insurers can charge based on age and preexisting conditions.
This is not true in Iowa. There, most individual market enrollees are in plans that have been exempted from these federal requirements.
These non-Obamacare-compliant plans are allowed to stick around because they were created before the Affordable Care Act exchanges launched, and Iowa’s state regulators have been more than willing to let them linger.
Because these noncompliant plans offer relatively skimpy coverage and, back in the day, were allowed to effectively screen out older and sicker patients, they’re cheap. As a result, they have siphoned off many of the healthier, younger people in the state.
