Report: Trump wants to deny Iowa’s Obamacare fix

For months, officials in GOP-controlled Iowa have sought federal permission to revitalize their ailing health insurance marketplace. Then President Donald Trump read about the request in a newspaper article and called the director weighing the application.

Trump's message was clear, according to individuals who spoke on the condition of anonymity to discuss private conversations: Tell Iowa no.

Supporters of the Affordable Care Act see the president's opposition even to changes sought by Republican states as part of a broader campaign by his administration to undermine the 2010 health care law.

In addition to trying to cut funding for the law known as Obamacare, the administration also is hampering state efforts to control premiums. In the case of Iowa, that involved a highly unusual intervention by the president himself.

And with the fifth enrollment season set to begin Nov. 1, advocates say the Health and Human Services Department has done more to suppress the number of people signing up than to boost it. The department has cut grants to groups that help consumers get insurance coverage, for example. It also has cut the enrollment period in half, reduced the advertising budget by 90 percent and announced an outage schedule that would make the HealthCare.gov website less available than last year.

The White House has yet to commit to funding the cost-sharing reductions that help about 7 million lower-income Americans afford out-of-pocket expenses on their Obamacare plans.

The uncertainty has driven premium prices much higher for 2018.

Administration officials make no apologies for actions scaling back federal support for Obamacare. Trump, Vice President Mike Pence and those carrying out the law at different agencies take most every opportunity to assert it is failing. Health Secretary Tom Price's abrupt resignation last week, prompted by the furor over his use of expensive chartered planes for work trips, is not expected to shift this approach.

'Obamacare has never lived up to enrollment expectations despite the previous administration's best efforts,” department spokesman Matt Lloyd said in an email last week. 'The American people know a bad deal when they see one, and many won't be convinced to sign up for ‘Washington-knows-best' health coverage that they can't afford.”

While the law's open enrollment period has attracted the most public attention, a more obscure battle within the administration over several states' proposed changes speak volumes about the president's approach to the law.

Two of Iowa's leading Republicans, Gov. Kim Reynolds and U.S. Sen. Chuck Grassley, issued statements Thursday evening after reading of Trump's opposition that they remain supportive of Iowa's request.

A spokeswoman for Reynolds agreed with the president that Obamacare is 'collapsing” and said Congress needs to pass a solution.

'The federal government recently deemed Iowa's Stopgap Measure application complete and is currently conducting a 30-day public comment period that ends Oct. 19. We are working with the White House and CMS to approve Iowa's Stopgap Measure in a timely manner to relieve 72,000 suffering Iowans from Obamacare,” the governor's statement said.

It was a Wall Street Journal article about Iowa's request that provoked Trump's ire in late August, according to an individual briefed on the exchange. The story detailed how officials had just submitted the application for a Section 1332 waiver - a provision that allows states to adjust how they are implementing the law as long as they can prove it would not mean lost or less-affordable coverage.

Trump first tried to reach Price, the individual recounted, but the secretary was traveling in Asia and unavailable. The president then called Seema Verma, administrator of the Centers for Medicare and Medicaid Services, the agency charged with authorizing or rejecting the applications CMS had been working closely with Iowa on its submission.

State Insurance Commissioner Doug Ommen has repeatedly described the stopgap measure as critical to expanding marketplace options. The plan would abolish the Obamacare exchange in Iowa and convert consumer subsidies into a type of GOP-styled tax credit. New financial buffers would help insurers handle customers with high medical expenses.

Without the measure, those who sign up for 2018 exchange coverage face premium rate increases of 57 percent on average from the single insurer participating.

Rod Boshart and James Q. Lynch of The Gazette contributed.