Iowa Affordable Care Act enrollment declines

Insurance Commission may extend transitional health plans

#x201c;By extending the grandmothered plan policy, we are following through on our commitment to protect those left behi
“By extending the grandmothered plan policy, we are following through on our commitment to protect those left behind by Obamacare,” Iowa Insurance Commissioner Doug Ommen says. (Rebecca F. Miller/The Gazette)

Approximately 11.4 million people enrolled in a health plan through the federal Affordable Care Act exchanges to cover the cost of their health care in 2019 — a decline of about 300,000 people from 2018, according to federal officials.

In Iowa, 49,210 individuals selected a plan through the ACA exchange for 2019, a decrease of about 4,000 consumers who signed up during the 2018 open enrollment period, according to a report released by the Centers for Medicare and Medicaid Services this week.

“I consider that 49,000 a relatively stable number,” Iowa Insurance Commissioner Doug Ommen said. “It has gone down to an almost entirely subsidy-eligible population, but that number is what we would have expected given the design of the ACA.”

About 11.8 million Americans signed up for plans through the ACA in 2018.

Nationwide, of the 11.4 million plan selections, 24 percent of enrollees were new to the exchange. Of the 49,210 total plan selections selected through the exchange in Iowa, a little more than 13,000 were new consumers and about 36,000 were re-enrolled from previous years.

The rate of 49,210 consumers for 2019 by the federal Centers for Medicare and Medicaid Services, or CMS, was the initial plan selection rate — meaning it was the total number of individuals who were enrolled in an exchange plan within the open-enrollment period.

However, the number of individuals still enrolled in their plan by the end of 2019 is likely to be much lower as individuals are dropped from their plans for unpaid premiums, the Iowa Insurance Division stated.

Individuals also may drop their plan if they take a new job offering an employer-based insurance plan, among other reasons.


The number of individuals who selected an exchange plan in Iowa in 2016 through 2018, according to CMS, were:

• 2016 — 55,089

• 2017 — 51,573

• 2018 — 53,573

The total on exchange plans held by Iowans at the end of year, 2016 through 2018, were lower each year, according to Iowa Insurance Division figures:

• 2016 — 40,438

• 2017 — 37,223

• 2018 — 37,505

Ommen said the enrollment in 2018 “was unusually high.” However, he added, Iowans also “dropped in higher numbers.”

“What I saw this year — and is consistent with what we expected — was that beginning of the year the number of 49,000 was much more closely in line with what we had previously seen moving from beginning of years to end of years, and then in turn the beginning of years,” he said.

Iowa Insurance states the total number of Iowans who held ACA-compliant plans at the end of years 2014 through 2018 were:

• 2014 — 38,524

• 2015 — 72,802

• 2016 — 74,790

• 2017 — 54,427

• 2018 — 37,884


The drop nationwide in plan selections during the 2019 open-enrollment period likely is due to a lower demand for marketplace coverage — thanks to growing employment rates and to the extension of non-ACA compliant plans, officials noted in the CMS report released this week.

According to the U.S. Department of Labor, the unemployment rate declined in the beginning of this year and hit 3.8 percent in February — a factor that CMS officials said suggested access to employer-based insurance plans increased.

Increasing employment rates could indicate this also is the case in Iowa, Ommen said.

In addition, Iowa was one of the states that allowed residents to retain health plans that are not compliant with ACA requirements in 2019 ­­— a move CMS promoted as an indication that Americans had access to affordable coverage options.


“Not extending the grandmothered plan policy would cancel plans that are meeting people’s needs today and, as a result, force people to decide between buying coverage they cannot afford on the individual market or going uninsured,” said CMS Administrator Seema Verma in a news release. “By extending the grandmothered plan policy, we are following through on our commitment to protect those left behind by Obamacare.”

Grandmothered plans, also known as transitional plans, are plans purchased after the ACA was passed but before it was implemented in 2014.

By the end of 2018, 31,868 Iowans received health care coverage through so-called transitional plans. In 2014, 75,580 Iowans had transitional plans.

Another non-compliant plan for Iowans called grandfathered plans, which predate the ACA passage in 2010, also are allowed to exist under a provision of the law.

In 2018, 31,997 Iowans held grandfathered health plans. This is a decrease from 2014, when 59,213 people in Iowa had those same plans.

With more individuals dropping from other, non-ACA compliant individual health plans, it’s unclear to state insurance officials where those individuals are getting their health coverage — or if they are covered at all.

“We’ll be doing a market scan during the course of this year to get better data on where those people went, but if you look at the employer based market, those numbers are continuing to show increase,” Ommen said.

CMS issued guidance to states this week on extending transitional plans for one more year. Ommen has not announced his decision, saying he wanted to give the guidance a careful look before extending these plans in Iowa.

He added he has “a lot of concerns” with these plans.


“These are closed blocks,” Ommen said. “That means if you look at the enrollment in these blocks, they are continuing to deteriorate as well.

“They are not a long-term solution and here we are, nine years after passage of the ACA, we’re still on an annual transition-plan approval process,” he said.

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