Iowa Individual Health Insurance Market

1. Iowa Individual Health Insurance Market

2. Iowa’s Pre-ACA Individual Market • Multiple carriers and stable market • Had one of the lowest uninsured rates in the country –but individual comprehensive health insurance plans were unaffordable for some modest income earners. • State high-risk pool (HIPIOWA) for individuals with persistent, high cost health conditions –but the rates were unaffordable for some.

3. Iowa’s Total Health Coverage Total Iowa Population 3,046,355 100% Employer-based 1,614,568 53% Non-employer-based 243,708 8% Medicaid 517,880 17% Medicare 456,953 15% Other Public 30,464 1% Uninsured 152,318 5% Source: Kaiser Family Foundation 2015 Data

4. ACA-Compliant Plans

5. Total Iowa Individual Plans

6. Insurance Rate - Family Income Cliff55 year-old couple • Age Income %FPL 2nd Low SilverMax % Inc Max Max Annual % of • (Reg 6) /mo ACA Monthly Annual APTCIncome _____________________________________________________________________________________________ • $32,317 199% $2724 6.38% $172 $2062 $30,627 6.38% • $64,798 399% $2724 9.69% $523 $6279 $26,410 9.69% • ______________________________________________________________________________________________ 55 $66,746 411% $2724 N/A $2724 $32,689 $0 49%

7. Insurance Rate – Family Income Cliff28 year-old couple w/ twins age 4 • Age Income %FPL 2nd Low SilverMax % Inc Max Max Annual % of • (Reg 6) /mo ACA Monthly Annual APTCIncome _____________________________________________________________________________________________ • 28+4 $48,954199% $2262 6.38% $260 $3123 $24,025 6.38% • 28+4 $98,154399% $2262 9.69% $793 $9511 $17,637 9.69% • ______________________________________________________________________________________________ 28+4 $101,106 411% $2262 N/A $2262 $27,148 $0 27%

8. Youth and its Subsidy Disadvantage <400% FPL • Age Income %FPL 2nd Low SilverMax % Inc Max Max Annual % of • (Reg 6) /mo. ACA Monthly Annual APTCIncome _____________________________________________________________________________________________ • 28 $32,317 199% $1328 6.38% $172 $2062 $13,872 6.38% • $32,317 199% $3510 6.38% $172 $2062 $40,053 6.38% • ______________________________________________________________________________________________ • $64,798 399% $1328 9.69% $523 $6279 $ 9655 9.69% • 62 $64,798 399% $3510 9.69% $523 $6279 $35,836 9.69%

9. On-Exchange Enrollment – Adverse Selection

10. Iowa Initiatives: Affordable Options for 2019 Farm Bureau / Wellmark Health Plan Department of Labor Multiple Employer Welfare Arrangements / Association Health Plans Fully insured / Self funded Department of Health and Human Services Short Term Limited-Duration Plans 1 – 364 days; renewable up to 3 years These are potential solutions for those individuals who are not eligible for ACA subsidies; these solutions do not address the structural issues with the ACA

11. MEWAs & AHPs – Federal Rule • AHPs may include ‘working owners’ • May be based on geographic area • MEWA – State Changes • Certificate of Registration required • Reporting requirements • Membership requirements • Consumer protections • Minimum benefit standards • Notice requirements Multiple Employer Welfare Arrangements & Association Health Plans

12. STLD – Federal Regulation • 12 month policies renewed for 36 months, up from 3 months • STLD – State Regulatory Issues • Out of pocket maximums • Minimum benefit standards • Enhanced consumer protections Short-Term Limited-Duration Plans

13. Direct Primary Care Agreements Bill • Agreement between provider and consumer (DPH statute) • Not insurance State Legislation – Last Year

14. Talk to a Licensed Agent

15. New Agent Fingerprinting & Federal Background Check • Compliance with NAIC Model Law • Consumer Protection Issue • Financial Exploitation of Vulnerable Adults • Imposes a duty to report on broker-dealers State Legislation for 2019-2020 Session

16. www.iid.iowa.gov Questions or comments?