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Iowa is asking the Trump administration for permission to jettison fundamental aspects of its Affordable Care Act marketplace, contending that a large-scale rewriting of the rules is the only way to prevent the state from becoming the first without any health plans available under the law next year. In an extreme plan that Iowa’s insurance commissioner submitted to federal health officials on Monday, the state would essentially take an estimated $350 million in federal ACA money that its residents and insurers would ordinarily receive next year and use it for different purposes. (Goldstein, 6/12)

"While legislation appears to slowly be moving at the federal level, it is unlikely any changes to the ACA will be enacted in time to keep Iowa's individual health insurance market from a total collapse leaving nearly 72,000 individuals with zero options to purchase health insurance for 2018," [Iowa Insurance Commissioner Doug] Ommen said.(6/12)

Commissioner Doug Ommen said his proposal would tweak Obamacare rules in ways to encourage more young and healthy people to buy such coverage. Those customers could be a counterweight to the health-care costs of older Iowans with chronic health problems. Ommen’s plan also would help insurers shoulder the burden of extremely expensive patients. And it would boil down carriers’ offerings to one standard plan, with uniform benefits. (Leys, 6/12)

Under Iowa’s plan, a 40-year-old making about $42,000 a year would pay an estimated $384 a month out of pocket next year to buy coverage, compared to $291 under Obamacare. In general, younger and wealthier people would fare better under the Iowa proposal, while older and poorer people would face higher costs. The program doesn’t include Obamacare’s cost-sharing reductions, which help poorer people afford to use their insurance plans by reducing their deductibles and out-of-pocket costs. (Tracer, 6/12)

Trump administration officials said they were open to supporting the Iowa proposal to the extent possible under the current health law. A White House official said the administration welcomed suggestions from the states to tweak the workings of the ACA within their borders, and officials “want to get to ‘yes’ with states. ”The Iowa proposal, which would offer one type of insurance plan and revamp the law’s subsidies that help people buy coverage, among other changes, would be in effect for 2018, though it could be extended. (Wilde Mathews and Radnofsky, 6/12)

Two carriers, including Wellmark, exited the marketplace earlier this year. The two remaining — one of which only sells plans in about five counties — hadn’t yet committed to selling health plans in Iowa’s insurance marketplace for 2018, a decision affecting 72,000 of the state’s residents. (Roubein, 6/12)

Iowa’s emergency proposal to prevent an Obamacare collapse will test how far the Trump administration is willing to go to let states prop up shaky insurance markets. The state’s stopgap plan to prevent 72,000 Obamacare customers from not having any options next year would represent a broad rewrite of Obamacare's architecture. (Pradhan, 6/12)