Utah or Massachusetts? No, it's Iowa

Gazette Editorial Board

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We met recently with two groups pushing for establishment of health insurance exchanges in Iowa. One of the 2010 federal Affordable Care Act's central requirements is for each state to establish an exchange, where individuals, businesses and organizations can select from a variety of insurance options. It's supposed to encourage competition among insurers and give consumers more affordable choices.

Both the Iowa Health Alliance and the Iowa Health Advocates want the Iowa Legislature to authorize work on an exchange sooner than later. They argue that waiting until July for the U.S. Supreme Court ruling on the ACA's mandate that every individual must have health insurance coverage is too late.

We agree. Legislators have to authorize a plan by Jan. 1; otherwise, the federal government will do it for us. Yes, depending on the November election outcome, Congress could throw out the exchange requirement, as well as any other or all parts of the ACA regardless of how the high court rules on the mandate.

But waiting because of the uncertainties doesn't seem wise.

Both of the coalition groups who spoke to us also talked about states with exchange plans already operating. The Iowa Exchange Alliance - a coalition of small business owners and the insurance industry - prefers the Utah plan. Iowa Health Advocates, advocating largely for consumers, leans toward the Massachusetts plan.

We reviewed each plan's websites. Both were pretty easy to navigate. Beyond that:

l Utah - The exchange, launched in 2009, was intended to focus on small businesses. Utah officials found that most of the state's uninsured were working for small businesses who increasingly could not afford health insurance. About 250 small employer groups have signed on since the exchange

l Massachusetts: Better geared for families and individuals seeking their own plans, and also has employer options. State statistics show 400,000 residents have bought through the 5-year-old exchange, with 98 percent of the population covered. Annual premium increases have slowed to 3 percent.

Each plan provides some lessons. But Iowa should not get hung up on any other state's model. Our exchange's governing body should be transparent, independent and represent both consumer and business interests. We also see merit in having the insurance industry serve in an advisory capacity only to avoid conflicts of interest.

Bottom line: Devise a plan to fit Iowans' needs.

On the Net:

n www.exchange.utah.gov/

n www.mahealthconnector.org/portal/site/connector/

n Comments: thegazette.com/

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