Medica: Ability to stay in Iowa insurance market ‘in question’

The last insurer offering individual health insurance in most of Iowa said Wednesday it is exploring whether to stop offering the plans.

Medica issued a statement that indicated it likely would pull out of Iowa's individual insurance market, barring changes with the Affordable Care Act at the national level. The Minnesota-based insurer said it needs to 'proceed with caution” after 'the two carriers with the most experience” in Iowa - Wellmark Blue Cross and Blue Shield and Aetna - pulled out.

'That means without swift action by the state or Congress to provide stability to Iowa's individual insurance market, Medica will not be able to serve the citizens of Iowa in the manner and breadth that we do today,” said Geoff Bartsh, Medica vice president for individual and family business, in the statement. 'Our ability to stay in the Iowa insurance market in any capacity is in question at this point.”

If Medica pulls out of Iowa's marketplace, the move would leave thousands of Iowans without any options to buy individual plans, including a majority of the 50,000 Iowans who buy subsidy-eligible plans through the ACA.

Medica has about 14,000 members in Iowa.

Des Moines-based Wellmark, Iowa's dominant health insurer, and Aetna both said in April they would stop selling individual health plans in Iowa starting next year.

Those decisions won't affect Iowans who bought family or individual health plans before Jan. 1, 2014, when the ACA took effect, or those who gained coverage through their employers.

Wellmark and Aetna said not enough young or healthy consumers enrolled in plans, which would have helped spread out costs. Wellmark had said it lost $90 million through the individual market in Iowa.

UnitedHealth Group pulled out of Iowa for 2017. In 2014, CoOportunity Health, a health co-op established with federal funding, was taken over by the state and liquidated after hitting financial trouble.

One other insurer, Gundersen Health Plan, sells individual health insurance policies on the exchange, but only in five of Iowa's 99 counties. The vast majority of Iowans looking for individual plans would have had to buy from Wellmark, Aetna or Medica.

Gundersen did not respond to requests for comment Wednesday.

Should Medica leave Iowa's marketplace, a majority of Iowans wanting individual plans would be left without a provider unless a new insurer comes to the state, said Peter Damiano, director of the University of Iowa's Public Policy Center.

Asked what advice he had for those Iowans, Damiano said 'be patient and see how things play out over the next few months to see if there will be any carriers or not.”

In Medica's statement, Bartsh said the company needs 'a stable market, established rules of the road and a clear understanding of the market's risk in order to price its products.”

Insurance carriers have until mid-June to detail plans if they will offer ACA plans on and off the marketplace.

Following Medica's Wednesday announcement, the Iowa Insurance Division reiterated its worries about the state's marketplace.

'Long-term, the individual health insurance market under the ACA was and still is unaffordable and unsustainable. Iowa needs Congressional action as soon as possible,” Iowa Insurance Commissioner Doug Ommen said in an emailed statement.

The announcement also came as The U.S. House of Representatives negotiates a revived replacement bill for the Affordable Care Act.

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