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Iowa officials withdrew a proposal Monday that sought to pull out of the Affordable Care Act and redirect federal money toward lowering premiums for younger participants under a separate program. If the Trump administration had approved Iowa's waiver request, it would have been the first to create a state-run alternative to the health exchanges required under the law championed by President Barack Obama. (Pitt, 10/23)

Iowa leaders pulled the plug Monday on their “stopgap” proposal to try to shore up the state’s rickety market for individual health insurance policies. With open enrollment set to start in less than two weeks, the state could no longer wait to hear if federal officials would approve the plan, which would have rewritten significant Affordable Care Act rules on how federal subsidy money is used. (Leys, 10/23)

"Obamacare is an unworkable law," Doug Ommen, Iowa's Republican-appointed insurance commissioner, said in a written statement. "The Stopgap Measure was an innovative solution to help thousands of Iowans. Unfortunately, Obamacare's waiver rules are so inflexible that the stopgap cannot be approved under terms that would be workable for Iowa." In addition, the plan may have fallen victim to Trump's recent decision to halt cost-sharing reduction payments to insurers. The state originally was counting on those funds to help finance its alternative coverage system, said Keith Mueller, interim dean of the University of Iowa College of Public Health. (Meyer, 10/23)

The waiver request had been closely watched by health policy experts as the most far-reaching effort by a state to sidestep requirements of Obamacare. Governor Reynolds, a Republican, said the Trump administration had tried hard to approve it, but had found it impossible to do so without violating the terms of the law. “Unfortunately, it now appears Obamacare’s waiver rules are as inflexible as the law itself,” Ms. Reynolds said at a news conference in Des Moines. “I’m extremely disappointed.” (Goodnough, 10/23)

The state’s withdrawal comes two months after President Trump telephoned a top federal health official with instructions to reject Iowa’s proposal. In announcing the withdrawal of what the state has called a crucial “stopgap” plan to prevent its marketplace from collapsing, Iowa Gov. Kim Reynolds (R) on Monday did not mention the president’s intervention, instead thanking Trump for trying to repeal the ACA and blaming the law itself for what she called its inflexibility. (Goldstein and Eilperin, 10/23)

The Iowa setup would have offered just one type of insurance plan in the individual market and reshaped the subsidies that help people buy coverage, among other big alterations to the infrastructure of the ACA. Iowa’s largest insurer, Wellmark Blue Cross and Blue Shield, had said it would reverse its plans to exit from the state’s individual market and would instead sell plans in every county next year if the state won approval for its proposal. On Monday, after Iowa’s decision, Wellmark said it “will continue to work on a long-term solution with state and federal officials.” (Wilde Mathews, 10/23)

Oklahoma also recently withdrew a waiver request to the federal government that would have stabilized its health insurance markets. The Oklahoma health commissioner said that approving the waiver would have helped more than 130,000 Oklahoma residents and reduced premiums by 30 percent. (Hellmann, 10/23)

Nick Podhajsky plans to get married this year for an unusual reason: health insurance coverage. The 44-year-old farmer had expected to tie the knot next year. But because Iowa’s individual health insurance market is in chaos—with competition disappearing and prices skyrocketing—his fiancee was potentially going to be left with no affordable coverage options for next year. So they’ve decided to hold the ceremony before the end of the year, allowing his bride-to-be to get coverage through his plan. (Demko, 10/23)