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Iowa’s last major Affordable Care Act insurer threatened on Wednesday to pull out from the state’s marketplace next year, the latest step in a sudden collapse of the state’s insurance marketplace that holds ominous signs for health care customers in states across the county. If Minnesota-based Medica follows through on its threat not to sell plans in 2018, Iowa could be the first state to lack any insurers on its exchanges in all but a handful of counties. (Johnson, 5/3)

“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,” Greg Bury, a company spokesman, said by email. “We are examining the potential of limited offerings, but our ability to stay in the Iowa insurance market in any capacity is in question at this point.” (Tracer, 5/3)

If Medica leaves, all but five counties in the state would have no insurers to choose from on the exchanges. Medica's announcement comes as insurers continue to get mixed signals from the Trump administration. (Hellmann, 5/3)

Medica’s announcement comes on the heels of word last month that Aetna and Wellmark Blue Cross & Blue Shield would pull out of Iowa’s individual health insurance market for 2018. Those are the only three choices for individual health insurance in most areas of the state this year. (Leys, 5/3)

One Iowan who will likely be affected if Medica leaves is Geoff Wood, who has purchased insurance through the exchange for every year that it’s been available. Wood owns a co-working space called Gravitate in downtown Des Moines, and often talks with people who are thinking about starting their own businesses. "That’s something that we talk a lot about, is what that’s going to be like to insure yourself for the first time," he says. "I’ve been very concerned about all the changes for that reason, just really stunting the growth of new business in our state. As people are kind of job-locked into their existing employment situations." (Boden, 5/3)

Aetna Inc. is quitting Virginia’s Obamacare market for 2018, the second state that Chief Executive Officer Mark Bertolini is exiting as he seeks to limit his insurer’s risks from the beleaguered health law....UnitedHealth Group Inc., which has largely stopped selling ACA health plans, said last month it was pulling out of Virginia. Also in April, Aetna said it wouldn’t sell Obamacare plans on Iowa’s market next year. (Tracer, 5/3)

Self-insurance, in which companies pay employee medical costs directly rather than buy a plan from a health insurance company, has traditionally been the realm of large corporations. It helped them avoid the hassle of navigating different insurance regulations for employees in different states, and having more employees helped them spread the risk of medical costs. But self-insurance has become more cost-competitive for smaller companies since certain employer mandates in the Affordable Care Act, commonly known as Obamacare, went into effect. (Marso, 5/3)

The Trump administration is still dutifully enforcing Obamacare's individual mandate, despite early signals it might undermine the unpopular linchpin of the health care law. Weeks after the close of tax season, the IRS continues to process penalties from potentially millions of taxpayers who refused to purchase health insurance last year. (Ehley and Lorenzo, 5/3)