Below are the publicly submitted comments regarding the Iowa Stopgap Measure.  More information about the Iowa Stopgap Measure can be found at https://iid.iowa.gov/iowa-stopgap-measure.


Jonathan M.- Ankeny, IA - June 12, 2017

As a small business owner, I purchase my family’s health insurance through Iowa’s individual market. I have always played by the rules, quietly doing the right thing for my family (and society) by following the law and purchasing health insurance.

I know that the cost of medical health care has risen and will continue to, so it is only logical that health insurance premiums will also rise.  I’ve never complained about having to pay more as I choose to look on the bright side that my family is healthy and we are able to afford to have health insurance coverage at all.  The rising costs have caused us to sacrifice things like enjoying lower deductibles and additional coverages.  But it is simultaneously both confusing and frustrating to hear that I will not even be able to purchase any insurance. How is that even possible when I have consistently done everything I was supposed to?

I see only two options moving forward:

  1. My family moves.  As a small business owner, my skills translate anywhere.  I was raised in Iowa though and I love it here. I consider this a non-option.
  2. My family goes uninsured.  This will sadly be the choice I will be forced to choose. That doesn’t mean we will stop needing medical care for regular check-ups or even emergencies.  We won’t stop needing medications just because I won’t have insurance coverage.

I just don’t understand what fellow Iowans will do if they have an even larger need for medical care.

I am hopeful that CMS will approve Iowa’s proposal because, as I understand it, it will allow me continue to purchase individual health coverage for my family.  I have done what has been asked of me. Now I need those who have been elected to solve problems like these to do whatever is needed to protect Iowa and its residents, because we have done and are doing our part.  


John S. - Altoona, IA - June 12, 2017

I'm a self-employed health insurance agent and clients have expressed a desire to pick and choose benefits and not have them packaged together with government mandated benefits. (Corridor restrictions , mandated maternity or mental health coverage that people don't want, & gender reassignment surgeries are all benefits that I and others want to carve out or choose without government imposed plans).


Tammy K. - Sherrill, IA - June 12, 2017

Iowa needs something like this - Let's do what we can to help implement it.  Thank you.  Tammy J. Klein, CISR, CPIW, Licensed Insurance Agent


AGNES C. - DES MOINES, IA - June 12, 2017

ONE OF THE 72000 THANKS YOU FOR YOUR UNDERSTANDING AND EFFORT WITH THE PROPOSAL. RETIRED THIS YEAR BUT I AM NOT ELIGIBLE FOR MEDICARE FOR TWO MORE YEARS. CURRENT AFFORDABLE CARE ACT USER SINCE ITS INCEPTION. MY HEALTH IS UNDER THE PREEXISTING WINDOW AND IS BEING TAKEN CARE OF NICELY. NOT ALL USERS COST THE INSURANCE COMPANIES MONEY AS I HAVE PAID MY PREMIUMS THIS YEAR WITH SUBSIDY AND HAVE NOT NEEDED TO GO TO THE DOCTOR ONCE LET ALONE TO THE HOSPITAL. LOOK FORWARD HEARING AN AFFIRMATIVE RESPONSE BY CMS IN THE FALL. I AM A RETIRED PROSTHETIST (ARTIFICIAL LIMBS) AND FULLY APPRECIATE WHAT LIFE WOULD BE LIKE TO AMPUTEES NOT TO HAVE THE ABILITY TO WORK WITHOUT INSURANCE TO PAY FOR A LIMB. PUTTING THEM ON PERMANENT DISABILITY WOULD BE TAKING US BACK TO THE ERA OF WOODEN PEG LEGS AND STICKING THEM IN A WHEELCHAIR. HOW MUCH WOULD THAT COST THE GOVERNMENT. THANKS FOR LETTING ME VENT A LITTLE. GOOD LUCK.


Elizabeth B. - Marion, IA - June 13, 2017

At last some movement to prevent Iowans going without health insurance in 2018. I have a pre-existing condition and have used ACA since it's inception. I have been very concerned that I won't be able to get coverage next year onwards if Medica were to drop out and no insurer under the AHCA would be willing to povide coverage. I hope this proposal is approved by the CMS and that the final legislation coming from Congress clearly covers pre-existing conditions with no waivers for any State to grant to insurers.


Kari S. - Ames, IA - June 13, 2017

My husband, three children, and myself will be part of the 72,000 Iowans that will be uninsured. Please provide the Stop Gap measures to ensure health coverage for my family and many others like us. And if at all possible, please work with insurance companies to lower premiums for hard working Iowans. Thank you.


Richard B. - Cedar Rapids, IA - June 14, 2017

There are interesting reports on things that have been done in Nevada and will possibly be done in New York to stabilize those individual health
insurance markets.  Basically Nevada requires any company participating in the (lucrative) Medicaid market to participate in the state's Obamacare 
exchange as well.  Why couldn't we do this in Iowa?  It seems like a simple fix that would greatly stabilize Iowa's market.

https://www.vox.com/policy-and-politics/2017/5/10/15615172/voxcare-how-nevada-fixed-obamacare
https://www.vox.com/2017/6/5/15742584/voxcare-new-york-obamacare-insurers


Rachel H. - Marcus, IA - June 14, 2017

As an Insurance Agent that sells health insurance in a small Iowa community I am glad to see our Insurance Commissioner working with the health insurance companies to come up with a plan that is best for the citizens of Iowa. All of my customers that are loosing coverage have bought their own individual plan from local agents not the federal market place. It is their desire to keep health insurance coverage and they are glad to hear Iowa is working towards a fix of the health insurance issues. Now we pray that the Federal Government will agree and support the Stopgap Measure.


Kristine W. - Arnolds Park, IA - June 14, 2017

PLEASE approve & support  this temporary StopGap measure until we can come together and agree upon a long term fix!


Chip C. - Sac City, IA - June 14th, 2017

I've reviewed Iowa's proposed Stopgap Measure to provide individual health insurance during 2018.  I urge the Federal Government to approve the Measure as a reasonable, and the only timely, way to avoid serious financial harm to the Iowans currently insured under an Affordable Care Act plan whose health insurance coverage will end on December 31, 2017.


Lorna C. - Dubuque, IA - June 15, 2017

Thank you Doug Ommen for having the guts to tackle the national healthcare reform problem and lead the way.  You make me proud to be an Iowan.  The ideas that you have show a lot of thought and promise.  You are making history.  I am now a fan.


Steve A. - Des Moines, IA - June 16, 2017

I am encouraged by your department's proactive efforts to maintaining  the individual health insurance market.  I for one need some clarity asap.  If your proposal falls through, then I must consider moving out of Iowa. I am a retired 62 year old lifetime resident.  If this fails, I hope you will allow Iowans to sign up for the high risk coverage I read about.  I am healthy and I know it's expensive, but it will work for some of us.  I am disappointed in the Iowa Congressional delegation for not working on a solution for us like you have. Please keep us informed of the status. Thank you.


Debora T. - Boone, IA - June 16, 2017

I am one of 72,000 Iowans who will be uninsured in 2018 without some kind of intervention. I strongly urge the CMS to approve the proposed Health Insurance Stopgap Measure.  Hopefully this short-term solution will prevent what would surely be a disastrous situation for the state of Iowa.


Don M. - Vinton, IA - June 17, 2017

I am retired. My wife and I work part time. We are on a fixed income. My wife's health insurance is costing us $1004.00 a month right now. That is NOT affordable. I saw someone on the news the other night and he said premiums for the older people will be going up if they get this insurance package passed for Iowans. Holy crap, we can't afford the premiums now. How the hell are we supposed to pay more? How is this a fix????? I guess we could sell our house and car so we can afford to eat and pay health insurance premiums. I don't understand you people. You say you're going to help but you're making it worse. I WON'T  pay higher premiums cause I can't afford them. We'll just take our chances. Thanks for nothing.


Vicky M. - Davenport, IA - June 17, 2017

My husband and I are small business owners and have always been self insured. Fortunately,  my husband will be eligible for Medicare next year.  I, however, am one of the 72,000 Iowans who will be left high and dry.  This is a scary prospect!  I'd like to thank Doug Ommen, our Iowa Insurance Commissioner,  for submitting this stop-gap measure.  I hope it is approved. It sounds reasonable and well thought out.  It seems totally ridiculous that we find ourselves in this predicament in the first place.  I wholeheartedly support this plan.  Thank you Doug Ommen!


Karen S. - Altoona, IA - June 19, 2017

I still fail to see how raising decreasing subsidies and raising  premiums for older Iowans is any kind of fix. The only good thing about would be if it were enough to entice the greedy insurance companies back into the Marketplace in Iowa. 

And when Joni Ernst comments that she doesn't know how much is too much for a consumer to pay for health insurance, ask her if she thinks half of one's annual income is too much, because that's where we're headed. How is it possible that we are still the only country without some type of single-payer system? Seems to work quite nicely for the rest of the world.


Kate P. - Bellevue, IA - June 19, 2017

What about the 55 year old couples making 64,101.00.  Have we decided they are the enemy of the state and can just pay through the nose? By the way, they are probably already paying through the nose with taxes. Implement that Cadillac tax.  Politicians are such cowards.


Barbara K. - Des Moines, IA -  June 20, 2017

The time for health insurance provided by private companies is over.  We need a single-payer, "Medicare for all" system.  Most Americans would welcome a slight increase in taxes to pay for such a system rather than having to pay tens of thousands of dollars annually in insurance premiums and deductibles.


Bruce S. - Grimes, IA - June 30, 2017

I support the Commissioner's proposal as an absolute necessity for Iowa.  It does a reasonable job keeping net premiums in line for many people otherwise losing insurance, though it does miss the mark for some subgroups.  The Commissioner's proposal emphasizes affordability but missed some affordability protections.  I don't have a solution for low income individuals moving from 94% actuarial value to ~70%, but at least a copay structure for doctor visits and prescriptions helps many of them.

If there is a way to tweak it for the following flaws -- without resubmission being required -- it would work better for these subgroups:

1) The proposal excludes anyone with employer-sponsored plans regardless of affordability.  Restore an affordability provision for people whose employer-sponsored plans exceed the ACA limits based on either percent of household income or employer safe harbors.  Small employers don't have to make the coverage affordable, and some large employers would rather pay the
penalty than offer affordable rates.  Affordability is a key goal in the Commissioner's Proposal.

2) The proposal excludes anyone eligible for even $1 of employer-sponsored coverage.  People not offered reasonable limits need access to the insurance offered under the Commissioner's Proposal.  Adequate coverage is one of the goals outlined in the Commissioner's Proposal.

3) People eligible for COBRA need access to affordable coverage.  COBRA, by law, is 102% of unsubsidized premium rate -- not affordable per ACA.  They should have immediate access to insurance offered under the Commissioner's Proposal.  Affordability is a key goal of his Proposal.

4) People whose group plan (or COBRA) terminating mid-month need to be able to start the Commissioner's plan without creating a coverage gap.  If I know coverage ends on the 16th, I should be able to start Commissioner's coverage without waiting until the following 1st of the month (causes 14-15 day coverage gap).

5) Those leaving Medicaid or CHIP need to be enrolled in a manner that prevents a coverage gap.  Recipients often aren't notified of termination until last few days of the month.

6) People experiencing a Qualifying Life Event should be able to have coverage retroactive to the QLE date as long as they apply within a short time thereafter (perhaps a week).  Making them wait 16-46 days for an effective date will cause needless coverage gaps.  Since these policies would be purchased through a vehicle other than Healthcare.gov, more realistic application deadlines and effective dates could be established (versus apply by 15th for coverage starting the 1st, which hammers anyone laid off on the 16th).

In 2015 and 2016 I was offered group coverage by an ALE (Applicable Large Employer) whose lowest single premium was $900/month in violation of the employer mandate.  It exceeded 12% of gross pay, when the law limited it to under 9% of net pay.  The employer chose to pay the penalty instead of offering the rates required by law.  Fortunately, my household qualified for an Exchange-based policy with subsidies because it was over 8.some% of household MAGI.  The Commissioner's Proposal would not have covered us.

Before the ACA, a national staffing firm's best group medical plan had a $35,000 annual benefit maximum (at outrageous prices) that would have made anyone offered it ineligible for the $1 million limit under Iowa's state-run High Risk plan.  People were forced to avoid this major staffing firm in order to keep their insurance.  Even with the ACA, companies might be penalized for not offering compliant coverage, but the penalty was small compared to the benefit costs avoided.

Looking at how the current Congressional landscape would affect Iowa:

a) It doesn't solve Iowa's collapsed individual market.  Even if nothing passed, the related uncertainty deters carriers.

b) A zero employer mandate penalty would increase the need for this plan, as employers could terminate group plans with no right of COBRA.

c) A zero employer mandate penalty would allow companies to jack premiums beyond affordable limits.

d) A zero employer mandate penalty would allow companies to slash the types of coverage offered and reinstate annual/lifetime benefit limits.

Again, I support the Commissioner's Proposal.  I encourage the above tweaks to make it even better, but not if it would require resubmitting a proposal. We don't have time for that, and we could lose the application grandfathering protection in the Senate bill.


Doug B. - Grimes, IA - July 7, 2017

Dear Mr. Ommen:

On behalf of the nearly 30 million Americans living with diabetes and the 86 million more with prediabetes, the American Diabetes Association (Association) provides the following comments on the state of Iowa’s Section 1332 Waiver Proposal  (Waiver Proposal).

The Association applauds Iowa’s commitment to ensuring the stability of its individual health insurance market and we share the state’s concerns about the ongoing “debilitat[ing]” effects of federal policy uncertainty on its market. We appreciate the importance of thinking creatively about potential solutions to ensure Iowans maintain access to a functioning individual market and agree that uncertainty at the federal level has made this task more difficult.

However, we are deeply concerned that the Waiver Proposal will have significant negative effects on Iowans’ access to affordable, adequate health insurance coverage and that these impacts would be felt most strongly by the low-income individuals, elderly individuals, and those with serious health issues or who are at greater risk of developing such health issues, including Iowans with diabetes.

Approximately 300,365 people in Iowa, or 11.4% of the adult population, have diabetes.  Of these, an estimated 75,000 have diabetes but do not know it, greatly increasing their health risk. In addition, 810,000 people in Iowa, 35.2% of the adult population, have prediabetes with blood glucose levels higher than normal but not yet high enough to be diagnosed as diabetes. Every
year an estimated 13,000 people in Iowa are diagnosed with diabetes. Considering this, ensuring Iowa residents with diabetes and prediabetes have affordable access to adequate health care is a key priority for the Association.  We respectfully offer the following comments addressing specific aspects of the Waiver Proposal.

Iowa’s Proposal Does Not Comply with Federal Law Safeguards that Limit the Scope of Section 1332 Waivers.
Section 1332 of the Affordable Care Act (ACA) authorizes states to apply to the Secretary of the Department of Health and Human Services to grant a waiver from certain of the ACA’s private insurance market reforms. Federal law specifies that the Secretary may not grant a waiver request unless the state demonstrates its proposal will: (1) provide coverage that is at least as comprehensive, in terms of the scope of benefits provided, as the essential health benefits package available in the state; (2) provide coverage and cost-sharing protections against excessive out-of-pocket spending that are at least as affordable as would be provided without the waiver; (3) cover a comparable number of residents as would be covered absent the waiver; and (4) be federal deficit neutral.

The first three of these “guardrails” are designed to ensure state residents are not made worse off by the state’s alternative coverage approach than they would have been under the ACA’s standard framework. Federal guidance has made clear that these guardrails require a waiver application to account for the impact of its coverage changes on a state’s vulnerable residents—including low-income individuals, elderly individuals, and those with serious health issues or who are at greater risk of developing such health issues—and that an application does not meet statutory requirements if it would make these vulnerable groups worse off.

Affordability Requirement
Most significantly, the Waiver Proposal would eliminate the ACA’s cost-sharing reduction subsidies, which substantially lower out-of-pocket spending requirements for enrollees earning between 100 percent and 250 percent of the federal poverty level (FPL). These subsidies currently help make coverage affordable for more than 50 percent of Iowans who have purchased a health plan through the ACA marketplace. Under the Waiver Proposal, an Iowan with an income of 140 percent FPL, who under current federal rules would be entitled to enroll in a plan with an actuarial value of 94 percent, would be shifted, instead, to a health plan with an actuarial value between 68 percent and 72 percent. Eliminating these benefits would make accessing needed care unaffordable for people with diabetes and prediabetes at lower incomes.

Further, the Waiver Proposal would significantly restructure the ACA’s income-based premium subsidy program. The state proposes to offer a premium tax credit that differs based on an enrollee’s age, as well as income. While it is difficult to evaluate with specificity the impacts of these changes on Iowans based on the limited information provided in the Waiver Proposal, it appears the intent of the program is to make coverage more affordable for younger enrollees and those with higher incomes, while providing less generous assistance for older Iowans and those with lower incomes. Unfortunately, both low-income adults and older adults are at higher risk for developing diabetes, so these changes could disproportionately impact people with and at risk for diabetes. Further, because the state’s proposed tax credit does not appear to adjust for geographic differences in premiums, enrollees living in relatively high cost areas—in particular, rural locations—will be exposed to relatively higher premiums. Finally, because it appears that income eligibility for the state’s tax credit is based on 2017 household income, those who experience a significant reduction in earnings in 2018—due, for example, to job loss—would receive less financial assistance than they would have under the existing subsidy framework. Considering all this, the Waiver Proposal does not meet the federal statutory requirement for cost-sharing protections that are at least as affordable as would be provided without the waiver.

Coverage Requirement
In the absence of formal analysis comparing the Waiver Proposal to the current market, a determination of precise coverage impacts is difficult. Nevertheless, it appears likely the proposal will reduce the number of Iowans with coverage, and especially Iowans with lower-incomes. First, because the Waiver Proposal would make health insurance much less affordable for many
Iowans, in particular those receiving cost-sharing reduction subsidies, it is likely some who are currently insured will forgo coverage under the Waiver Proposal due to affordability concerns. While the Waiver Proposal attempts to make financial assistance available to a broader swath of state residents, by  extending premium tax credits to those earning up to 400 percent of FPL, there is no basis in the submission to support a conclusion that this limited assistance would be sufficient to offset coverage losses among the many consumers likely to see their total costs rise substantially. Further, current enrollees may be especially likely to drop coverage because the Waiver Proposal seeks to waive the ACA’s individual mandate, thus eliminating this additional incentive for individuals to maintain insurance.

The Waiver Proposal apparently also seeks to encourage enrollees to remain insured in the absence of a mandate by imposing an unprecedented continuous coverage requirement applicable to special enrollments. We are deeply concerned this provision of the Proposed Waiver contravenes federal statutory protections regarding guaranteed availability of coverage, which are not waivable under Section 1332. If established, this requirement would, by design, impose an additional burden on consumers seeking to access coverage and would almost certainly result in a further overall reduction in covered lives over the course of the plan year.

Based on this, it appears likely this Waiver Proposal will result in fewer Iowans having coverage than would otherwise and does not meet the federal requirement that at least a comparable number of state residents will have insurance coverage under the waiver as would be insured without it.

Iowa’s Proposal Does Not Satisfy Federal Requirements Related to Input from the Public and Stakeholders
Section 1332 contains numerous requirements designed to ensure a state’s waiver application has resulted from a transparent and deliberative process that drew upon public input and stakeholder consultation. Waiver applications also must include actuarial and economic analysis and extensive supporting data to demonstrate compliance with the guardrail requirements, as described most recently in the Centers for Medicare and Medicaid Services’ Section 1332 waiver application checklist.

Iowa forthrightly recognizes that these requirements make Section 1332 waivers a poor mechanism for “crisis management” and acknowledges that it has failed to satisfy many of them. For example, the state did not allow a public notice and comment period prior to submitting the application to federal officials, did not hold required public hearings prior to submission, did not conduct required consultation with Federally-recognized Indian tribes, and did not provide in its application any analysis or data showing how the Waiver Proposal might comply with the federal guardrails. Nevertheless, Iowa suggests it should be relieved of these federal law obligations.

The state’s procedural failures are not mere technical rules violations. They have made it impossible for the public and critical stakeholders to inform and influence in a timely fashion a state proposal that would make significant changes to existing law. By failing to include required analyses and data showing how the Waiver Proposal complies with federal safeguards—protections operative by statute no matter the length of the requested waiver—Iowa has made it more difficult for the public, stakeholders, and federal officials, to understand how the proposal will affect residents’ access to affordable coverage.

Conclusion
Iowa’s Section 1332 Waiver Proposal does not meet the federal requirements because it would make coverage less affordable for many Iowans with diabetes and prediabetes, especially older individuals and those with lower incomes, and likely would reduce health insurance coverage among these groups.  In addition, we are troubled that the Waiver Proposal was developed and submitted to federal officials without the benefit of public comment, hearings and stakeholder consultation.  The Waiver Proposal also lacks the supporting analyses and data that would allow the public to evaluate the wide-ranging effects of the state’s plan. These omissions, which run afoul of federal requirements governing the issuance of the Section 1332 Waiver, undercut the ability of the public and critical stakeholders to understand and be heard on a proposal that would make significant changes to the state’s insurance market and to federal tax benefits received by thousands of Iowans. For these reasons, the Association recommends the state not implement the Waiver Proposal as written.  If you have any questions or need additional information, please contact me.

Sincerely,

Doug Bickford
Iowa Executive Director

1. In addition, it is not clear Iowa has met the Section 1332 requirement that it have legislation establishing authority to pursue a Section 1332 waiver.
2. In the alternative, the state suggests its application should be approved pursuant to the President’s January 20 executive order directing federal agencies to minimize the economic burden of the ACA. Yet, the executive order directs federal agencies to act “consistent with applicable  law” and does not purport to suggest that they disregard existing federal requirements.


Patti N. - Cedar Rapids, IA - July 14, 2017
I am currently receiving health insurance under ACA as 59 year old.
 
Anything that can be done to try to help us to get some kind of insurance for 2018 and beyond is better than waiting.
 
Medica, possibly, is the only company for 2018 in Iowa, but at a premium increase of 44%, it is unlikely that I will be able to afford, on my pension as a retired person, to purchase health insurance for next year, or beyond.
 
I am very concerned about this situation, obviously.  I do not receive Medicaid benefits, I have to pay for my health insurance and receive a small subsidy from the ACA for the remainder.  The insurance that I have this year can't really be used.  The deductible with Aetna is over $4,800 and can't be used other than for a yearly exam. 
If I have no insurance in subsequent years, I will not even have these basic, once a year exams for basic care and women's care.
 
Please continue to press for some sort of solution for the Iowa consumers of health insurance in this matter.
 
Discrimination against 50-64 year olds should not be happening in a democracy, and not in the state of Iowa.
 
We are a progressive state.  I would like to think that we can come up with a solution for older Americans, and all Americans to lead the way for a plan that might be set as an example for other states who lose all insurance carriers because they don't feel that they are making enough money from us. 
 
Thank you for your attention in this matter.
Mr. & Mrs. Ronald D. - Clive, IA - July 14, 2017

Click here to view the letter.


Jean E. Robillard, MD, Vice President for Medical Affair & Dean, Carver College of Medicine - Iowa City, IA - July 14, 2017

Click here to view the letter.


Jennifer Vermeer, President and CEO University of Iowa Health Alliance - Des Moines, IA - July 18, 2017

Click here to view the letter.


Dr. Doug L. - Ames, IA - July 18, 2017

Our family appreciates Commissioner Ommen’s collaborative effort with Iowa based insurance companies and CMS to work toward stabilizing the Iowa individual insurance marketplace with this 1332 State Innovation Waiver, the “Proposed Stopgap Measure” (PSM). We support this effort and feel it will benefit many Iowans. Importantly, Iowans need access to reliable catastrophic health insurance. One can debate what exactly is “health care” but all Iowans are just one minute from a car accident, an unexpected fall, a new finding on a mammogram or something unexpected during a physical examination. Health care remains expensive and more market-based changes are necessary long-term to bring down health care costs in Iowa and nationwide, but Iowans need options for 2018 for catastrophic health insurance and if only one insurer is in the market, there is no true choice. Alaska was recently granted a 1332 waiver request to stabilize their individual marketplace and as I read this proposal, this shares many of the concepts of the Alaska plan to stabilize the individual market with a reinsurance proposal and work toward affordable choices for consumers. At the same time, it retains many of the features of the ACA, specifically it excludes yearly or lifetime caps in coverage and ensures individuals with pre-existing conditions or complex medical conditions can obtain health insurance for treatment. When I met with CMS Director Verma and HHS Secretary Price June 21, 2017 in the Roosevelt Room of the White House, they expressed a strong desire to work with the individual states to resolve the problems of the Affordable Care Act. Leaving Iowa with only a single insurance company offering plans is comparable to a single gas station selling gasoline. They would enjoy a monopoly and prices will rise accordingly, in this case Medica is proposing a 43% increase in the average premium. This occurs after Iowans have incurred premium increases of 70-100% since the passage of the Affordable Care Act. My family asks on behalf of 72,000 Iowans that the Iowa Proposed Stopgap Measure be granted to stabilize the individual insurance marketplace in Iowa, ensure catastrophic health insurance is available to Iowans and help insurance companies reduce their reinsurance losses.


Anonymous - Council Bluffs, IA - July 19, 2017

Click here to view the letter.


Nicole K. - Waukee, IA - July 19, 2017 

Click here to view the letter.


Douglas Cropper - President & CEO of Genesis Health System - July 19, 2017

Click here to view the letter.


Public Hearing from Council Bluffs - July 19, 2017

Click here to view the letter.


Michelle B. - Council Bluffs, IA - July 20, 2017

Click here to view the letter.


Todd Berryhill, MD - President, Board of Directors of McFarland Clinic - July 20, 2017

Click here to view the letter.


Bryan  A. - Sioux City, IA - July 21, 2017

Click here to view the letter.


Mary T. - Des Moines, IA - July 21, 2017

Iowa’s 1332 Waiver: A “Proposed Stopgap Measure” for the Individual Market

The Child and Family Policy Center (CFPC) appreciates the opportunity to weigh in on the state’s Proposed Stopgap Measure (PSM). CFPC recognizes that, as in other states, there are problems in Iowa’s individual marketplace. Steps absolutely need to be taken to ensure that Iowans purchasing insurance through the exchange have access to affordable and meaningful health insurance that covers the services they need to be healthy. 

However, CFPC has concerns with the Proposed Stopgap Measure. Our concerns are two-fold: the process by which the waiver proposal was developed and elements of the proposal itself, which would significantly harm Iowans’ access to affordable health insurance coverage. More details on our concerns are outlined here:

1. The state did not follow proper procedures for preparing and submitting a waiver proposal. The state submitted the proposal without allowing for the transparency and public discussion required under law.

•       The state submitted the proposal without a public notice and comment period, did not hold required public hearings, and did not consult with federally recognized Indian tribes.
•       The application was submitted without any analysis or data showing how the Proposed Stopgap Measure (PSM) would comply with federal guardrails.

Since the stated impetus of the PSM – no insurers planning to offer coverage in the individual market in 2018 – has been averted, Iowa should revise and resubmit the application following statutory requirements for public input and analysis.

2. The PSM would have significant negative effects on Iowans’ access to affordable health insurance coverage and would therefore violate the “guardrails” in the law. Without a full analysis of the impact of the PSM, it is difficult to evaluate the proposal’s impact with any specificity, but based on the information provided, it appears the PSM would:

•       Make coverage less affordable for many Iowans. Because the PSM would eliminate the ACA’s cost-sharing subsidies and significantly restructure its income-based premium subsidy, it is likely to make coverage less affordable for Iowans, violating one of the four “guardrails” in the law. 

For example:
o       Under the PSM, an Iowan with an income of 140 percent FPL, who under ACA rules would be entitled to enroll in a plan with an actuarial value of 94 percent (which provides more coverage than a platinum plan), would be shifted instead to a health plan with a value of between 68 and 72 percent. 
o       Although the proposal lacks a detailed explanation and analysis of the proposed changes in the premium subsidy, it appears the intent of the PSM is to provide more assistance to younger individuals and those with higher incomes, and provide less assistance to older individuals and those with lower incomes.

•       Result in fewer Iowans having coverage, which violates another of the four “guardrails” in the law. A few features of the proposal are likely to contribute to a loss of coverage:
o       The PSM would make health coverage much less affordable for many Iowans. 
o       The PSM would waive the individual mandate, which has been shown to contribute to higher enrollment.
o       The PSM would impose a continuous coverage requirement for special enrollments, creating a barrier to insurance for Iowans unable to maintain coverage because they could not afford to do so.

There are common sense policy fixes Iowa could take to improve the individual markets and build on the coverage gains launched by the ACA. Iowa’s PSM does propose creating a reinsurance program which will help stabilize the market but there are other steps the state could take to boost enrollment and increase insurer participation. For example, Iowa could end transitional
policies that keep healthier individuals out of the marketplace, invest in outreach and enrollment assistance to help attract healthier enrollees into the market and invest more in the design and user testing of its IT systems to make the enrollment process as simple and quick as possible.

The Child and Family Policy Center encourages the state to pursue these options instead of pursuing a waiver that would make coverage less affordable for consumers, especially those with lower incomes and living in higher-cost parts of the state.


Les B. - Cedar Falls, IA - July 23, 2017

Next year I will be one of the estimated 72,000 Iowan’s who may be left with no option to purchase health insurance.  My primary concern is quite simply that there will be one or more insurance carriers offering individual products in 2018 (and beyond).   My secondary concern is that they are affordable.  The Iowa Stopgap Measure lays out both the problems with the current market and provides a framework to incentivize participation in the market.  As such I strongly support the Federal Government approving the proposed stopgap measure as a way to stabilize the Health Insurance market in Iowa for 2018.


Lucy H. - Tipton, IA - July 24, 2017

Dear Insurance Commissioner Ommen,

Please do what you can to approve the Iowa Stopgap Measure for health insurance. My family is among those who will loose our health insurance next year if nothing is done.  We have always gotten our insurance through Farm Bureau but the premiums have gone up so much every year and now we may not be able to even get insurance at all. Please act so we can continue to get health insurance!

Sincerely,
Lucy H.


Jane P. - Hancock, IA - July 24, 2017

Dear Insurance Commissioner Ommen,

I am a single, retired individual living on a fixed income who is insurance poor.  I am barely able to cover my premiums and deductible, and have no idea where I will find coverage next calendar year.  If I find coverage, I may not be able to afford it, as I hear it will be more expensive than this current year.  Something must be done!  Help those of us who have always paid our own way and not taken government handouts.

Sincerely,
Jane P.


Melinda V. - Davenport, IA - July 24, 2017

Dear Insurance Commissioner Ommen,

I support the "Iowa Stopgap Measure" Without this plan, health insurance will either not be available to me or will be even more unaffordable for me, which means i will have to be without insurance. We the people deserve to have insurance and demand that choices be made available to us.  We demand immediate attention! Im certain if our government officials/leaders were in this situation something would have been put in place immediately.

Sincerely,
Melinda V.


Janelle J. - Ankeny, IA - July 24, 2017

Dear Insurance Commissioner Ommen,

Please support implementation of the Iowa Stopgap Measure. I am a 50-something single business woman in generally good health. I started a business approximately two years ago within my career profession. As a single-member LLC corporation, I have to obtain my own health insurance and can not be part of a larger pool. I signed up through ACA with Wellmark. I had no anticipation that I would lose my health insurance after only a year of signing with ACA. The uncertainty makes it difficult for me to plan and anticipate my own budget needs as a business owner.   I started the single-member LLC to optimize retirement investments so I would not have to depend so heavily on the government or state. I also have a few years before I can access Medicare.   Please use this proposal as a way to bring some stability in the short term while more conversation and debate can occur at the federal level. It is sad to see investment dollars from my business having to go into providing myself healthcare. I have already paid $7000 this year in health premiums.  The thought of another 40% increase is sad. It becomes a negative to anyone wishing to own their own business in the state of Iowa. The stopgap measure will at least bring some stability for another year while better answers can be developed.

Sincerely,
Janelle J.


John C. - Griswold, IA - July 24, 2017

Dear Insurance Commissioner Ommen,

This plan needs to happen. We are a young, farming family with over half of our salaries going towards healthcare and we rarely get sick but have to have insurance or will get fined. It is already unaffordable for us who live paycheck to paycheck just to try and make a living. Now we are going to just be dropped with no back up plan in place, so that means making the already unaffordable to impossible! Our child has to have medical care to go to school but how can we afford it if nothing will help?! This plan needs to be in place until a solid healthcare plan is in place. It will effect the hard working, blue collar americans. Our farming family does not have an employer, so makes this so called plan a joke since we are our own bosses that make a living and feed everyone else.

Sincerely,
John C.


Douglas G. - Monroe, IA - July 24, 2017

Dear Insurance Commissioner Ommen,

My wife and I have worked our entire careers and saved for retirement so that we could retire before we reached age 65.  We've anticipated paying for our own personal health insurance for a couple of years and although the premiums are quite high ($1700/month) we're able to handle them.  NOW, at age 63, we're in a position where we may have NO INSURANCE OPTIONS, perhaps only one provider (Medica) to purchase our health insurance from AND premiums that may be well over $2500/month.

There are 72,000 of us in the state of Iowa in this predicament!

That's why I support the "Iowa Stopgap Measure".  PLEASE take steps to get this approved.  No health insurance at our age is NOT an option and 43% increases (on the average) is not affordable.

Sincerely,
Douglas G.


Gina J. - Luzerne, IA - July 24, 2017

Dear Insurance Commissioner Ommen,

My health insurance is vital to me and my personal and financial future. It is imperative you support the the Iowa stop gap measure to assure I do not lose coverage. I implore you to do the right thing! think of your constituents! Do not strip away my health insurance!

Sincerely,
Gina J.


Timothy K. - Sioux Center, IA - July 24, 2017

Dear Insurance Commissioner Ommen,

As a small business owner, the availability of individual health insurance is vital for me to continue my operation.  Premium increases over the last two years have been extraordinary. Now we are facing  cancellation. Please do everything possible to obtain a temporary fix while  congress works toward a permanent solution.

Sincerely,
Timothy K.


Barbara J. - Oelwein, IA - July 24, 2017

Dear Insurance Commissioner Ommen,

Please act to approve Iowa's Stopgap Measure. I am one of the Iowans who otherwise will be without health insurance options. That would be the first time I have not had health insurance. I am already paying a very high monthly payment for health insurance.

Sincerely,
Barbara J.


Floyd S. - Moorland, IA - July 24, 2017

Dear Insurance Commissioner Ommen,

My wife and myself moved to Iowa in 2014, from Texas. I had medicare, but my wife, being under 65 had a very good PPO through her employer.

We are both retired, and she had to get her own insurance, especially, since she has a chronic pain condition. Since we had Farm Bureau for our cars and personal property, it was only right for us to use Farm Bureau for her insurance needs. The first two years she was able to get a PPO through Farm Bureau, even though it had a costly premium, but a manageable deductible, we were satisfied. She continued to see her Dr. that was in Texas, and the insurance covered his cost, after all deductibles were met. We were well pleased. Starting this year, 2017, we were told by our Farm Bureau that there will no longer be PPO's offered in the state of Iowa., and the only insurance we could get was an HMO.  It came with a high premium, plus a high deductible.  What made matters worse, she had to get a referral every time she had to see her Dr. in Texas. But, to make matters worse, he is out of network, and that did cause much stress. She had established a HSA several years ago, and being able to put money in that account made it a lot easier to use this HMO plan.

I would like for any new health insurance be like a PPO. Have a premium and deductible that is with in reason. Have the ability to choose and see any Dr. and the keeping of coverage of pre-existing conditions.

Sincerely,
Floyd S.


Donita C. - Newton, IA - July 24, 2017

Dear Insurance Commissioner Ommen,

I have always had good insurance coverage through my employers. I am now retired and the insurance available to me this year is over $800/month with a $6400 deductible. Thankfully I will be eligible for Medicare mid-year 2018, but have been putting off any but the absolutely essential doctor visits because of the out-of-pocket costs. I am doing no preventive tests this year (such as a mammogram) because of the costs involved.

We Iowans definitely need some kind of stopgap measure to ensure that affordable coverage can be obtained.

Sincerely,
Donita C.


Ryan G. - Worthington, IA - July 24, 2017

Dear Insurance Commissioner Ommen,

As a young farmer I will say that I need to have access to affordable health care. That is one of my biggest expenses right now. It's borderline not affordable! Please help to make it justifiable to have health insurance. Thank you.

Sincerely,
Ryan G.


Jill E. - Johnston, IA - July 24, 2017

Dear Insurance Commissioner Ommen,

I am writing as I am one of over 70,000 individuals in Iowa that will lose their health coverage at the end of the year. Ironically it is because of the ACA (and my compliance with it) that I will be losing my coverage. I am self employed and long story short, I had cancer as a teenager with life long complications but only really need to see a doctor about once a year now plus labs and medications. I ALWAYS had my own coverage after being rolled off my parents self employed plan when I finished college, Wellmark BC/BS had a policy BEFORE the ACA that they would not kick you off of insurance but they did not have to put you in a better/cheaper pool either, so I have Paid handsomely for my own individual plan for about the last 10 years, I'm fine with that, what is NOT OK is kicking everyone off of their insurance because about 5 years ago I took a job that had a group plan, this was right as the ACA was taking effect, in the process I gave up my "grandfathered" plan, when I left that job and went back to being self-employed I was able to get back on Wellmark BC/BS  but in a new ACA plan- still super expensive like always but again that was fine as long as I was able to have insurance. The problem now is Wellmark BC/BS is dropping all individual plans that are ACA compliant and for the first time in my 34 years of life I will be uninsured!!!! Despite me doing everything correct and paying more than my fair share due to pre-existing conditions, I am fine with paying more (within reason) but to just drop the plan all together and not allow me back on to my old grandfathered plan or to offer alternatives for the 70,000+ Iowans who are self employed, small business owners or farmers like myself is Cruel, unfair, and completely against everything America stands for especially free enterprise and those who create jobs- we should not be punished because we don't work for a big corporation or the bloated federal government or because of some broken healthcare fiasco designed to break the system- congrats, it worked, at least here, NOW WHAT??!!

Please allow the Stop gap measure to be approved. Or if there is any political/legal pressure that can be brought to bear on unscrupulous insurance companies please do it now, before myself and other hard working Iowan's are left without any insurance.

Sincerely,
Jill E.


Jerry and Carol H. - Newton, IA - July 24, 2017

Dear Insurance Commissioner Ommen,

We support the Iowa Stopgap Measure. We are both 63 and retired and would really like to have affordable health insurance next year.

Sincerely,
Jerry and Carol H.


Tim & Jane R. - Carroll, IA - July 24, 2017

Dear Insurance Commissioner Ommen,

My wife and I need your help so we can have and afford health insurance this coming year.  We will have paid a total of $21,182 by the end of 2017 for our health insurance.  That is for a policy with a $5,600 deductible and $7,150 out of pocket per person.  Now they're telling us that for 2018 we may have no coverage.  For this reason we support the "Iowa Stopgap Measure" and hope you'll support it also.  It is essential to have it approved so Iowa farm families and small business owners can have health insurance available to them.

Sincerely,
Tim & Jane R.


Paul and Sarah M. - Newton, IA - July 24, 2017

Dear Insurance Commissioner Ommen,

We have had a Blue Cross Blue Shield health insurance policy through Farm Bureau for over 40 years.  Two years ago, we switched from our traditional PPO policy to a HSA policy in order to save money on our premiums.  At that time, our premiums were $28,000 per year.  We were never told that our new policy was different in that it could be terminated because it was compliant with the Affordable Care Act.  We have never qualified for a subsidy.  I am in favor of universal health coverage for every person in the United States as I feel that health care should be a right and not a privilege.

As Congress has failed to act to stabilize the health insurance markets in the country, those of us in Iowa with individual plans are becoming increasingly nervous about our healthcare options at the end of 2017.   I am hopeful that this stopgap measure for individual policy holders in Iowa can be approved in order to allow Iowans like me to keep continuous coverage.  I continue to be hopeful that Congress will see the benefit to having health insurance available to all citizens.

Please approve this Stopgap Measure so that I along with many other Iowans won't be left without health insurance.

Sincerely,
Paul and Sarah M.


Coree S. - Treynor, IA - July 24, 2017

Dear Insurance Commissioner Ommen,

My husband, son, and I are highly i favor of the stop gap measure.  Over the past 4 years our policies monthly premiums have rapidly increased, while our benefits have decreased.  We have had services denied and had to fight to prove they were covered by our policies.  As a farm family, we need help to curb the outrageous cost of our insurance.

Sincerely,
Coree S.


Betsy G. - Woodbine, IA - July 25, 2017

Dear Insurance Commissioner Ommen,

I support the "Iowa Stopgap Measure". Without this plan, health insurance will either not be available or will be even more unaffordable for 72,000 Iowa families including over 6,000 Farm Bureau members in 2018. This stopgap plan allows Iowa to have an option for individual health insurance in 2018 - allowing time for long term solutions to be put in place. Without this effort, insurance will be unavailable for thousands of Iowa's self-employed, small business owners, and farm families, including my own. It is essential to approve Iowa's stopgap plan right away.

Sincerely,
Betsy G.


Nick P. - Traer, IA - July 25, 2017

Dear Insurance Commissioner Ommen,

Everyone knows the Affordable Care Act (ACA) is a flawed piece of legislation and causing incredible price increases in the costs of health care and insurance market, if there are even policies available to be purchased.  However, the fix to ACA seems to be a long way off and a difficult process to achieve a remedy.  That said, in just a matter of 5 plus months, I as well as my fiancé will no longer have coverage with our existing providers in Iowa.  We are in our 40's, non smoking, and by all accounts very healthy individuals.  We are the type of business that under normal circumstances, any insurer would be happy to write.  We just want to pay a reasonable premium for reasonable health coverage.

Since ACA wont be fixed by January 1, 2018, it is my understanding that there is a stop gap measure that could possibly provide an option for the 2 of us, as well as thousands of Iowans who are in the same situation.  Please take action on the Iowa stopgap measure to ensure that thousands of Iowans are not at risk of a catastrophic health loss or severe financial loss due to the dysfunction of the individual insurance market.

Sincerely,
Nick P.


Lorna S. - Jefferson, IA - July 25, 2017

Dear Insurance Commissioner Ommen,

I support the "Iowa Stopgap Measure". I am one of those 72,000 Iowa families that will lose my healthcare coverage at the end of the year.  I have paid my own health insurance premiums for over 40 years and now I will not be able to buy insurance coverage. Iowa's stopgap plan needs to be approved immediately.  Not having health insurance is a scary, worrisome situation that I don't want to be in. Our freedom of choice has been taken away!

Sincerely,
Lorna S.


Brent N. - Humboldt, IA - July 25, 2017

Dear Insurance Commissioner Ommen,

I am an Iowa farmer and support the Iowa Stopgap Measure. My wife and I have a have a health care plan and also have another policy for our son who is entering the operation. My entire operation is at risk without health insurance, and it has currently gotten to an almost in affordable cost. Please help support this bill to make sure something is available to my family.

Sincerely,
Brent N.


John F. - Gowrie, IA  - July 25, 2017

Dear Insurance Commissioner Ommen,

I am a self employed farmer in Webster county.  My wife and I have our own health care insurance with Wellmark Blue Cross and Blue Shield.  We will no longer have it after December of this year.  Please work to get approval of stopgap insurance for individuals like myself.  Thank you for your cooperation.

Sincerely,
John F.


Michael & Dawn S. - Victor, IA - July 25, 2017

Dear Insurance Commissioner Ommen,

We are farmers who have had our health insurance with Wellmark for many, many years. In 2015 we had had such premium increases we sought to find a cheaper solution and switched our plan. That was a huge mistake as now we will not be "grandfathered in" to keep our insurance. Something needs to be done so that people like us can keep our insurance at an affordable rate. I totally support the "Iowa Stopgap Measure". Please approve this plan to ensure we are not left without health insurance.

Sincerely,
Michael & Dawn S.


Greg H. - Solon, IA - July 25, 2017

Dear Insurance Commissioner Ommen,

Health insurance is very important to t hose of us involved in America's most dangerous line of work Agriculture. Most are self employed, family farms like ours. It has become most difficult to maintain and pay for coverage, we have had to do without things in order to continue to be able to make premium payments that have doubled in the last four years.  Something has to be done to avoid losing coverage on January 1, 2018, which is why I support the Iowa Stopgap Measure. Please act to approve the Iowa Stopgap Plan to keep thousands of Iowans like us from losing health insurance options.

Sincerely,
Greg H.


Landi L. - Ellston, IA - July 25, 2017

Dear Insurance Commissioner Ommen,

I write to support the "Iowa Stopgap Measure" because I am one of over 72,000 Iowans who will lose their health insurance in 2018.

My family homesteaded in Southern Iowa over 160 years ago, and have been farmers here ever since.  During my lifetime, we have always purchased individual health insurance ourselves, because as farmers and small business owners, we don't have an employer-sponsored health care plan.  The recent increases in the cost of health insurance have been tremendous.  I am on a heath care plan by myself, and last year, my deductible tripled (from $1000 to $3000), my maximum out of pocket over doubled (went from $3000 to $7500) and my co-pay and premium increased.  As outrageous as that sounds, that is nothing compared to being cancelled, like I am going to be for 2018!  I am one of the people that is getting "kicked off" by Wellmark, because I had a new plan in 2016 (because here again, I was "kicked off" my old Wellmark plan because it wasn't ACA approved) and not grandfathered in.

The Iowa Stopgap Measure will hopefully help people such as myself so we don't have the tremendous burden of having a life-threatening disease, illness, or injury and no health insurance to cover such medical problems.

Sincerely,
Landi L.


Tim N. - Des Moines, IA - July 25, 2017

Dear Insurance Commissioner Ommen,

I support the Iowa Stop Gap Measure as a way to help out the thousands of Iowans who have been forced into a situation, not of their own making. The flaws in the ACA law have crippled the health insurance industry in Iowa and to the detriment of its citizens.  It is a shame that this has happened by the hands of our government officials who consequently exempted themselves from their own law.  I have a daughter who's family is facing the prospect of having no health insurance coverage which puts her herself, her husband, and three children at considerable risk.  Please support this plan and let the State of Iowa fix the mess handed down by the United States government.

Sincerely,
Tim N.


Gail O. - UNKNOWN TOWN/STATE - July 25, 2017

To justify dropping 70,000 people with individual policies, Wellmark has stated that they lost 70 million dollars in the last three years.  My question is, what is the real bottom line?  The public should have access to that number.  I understand the insurance industry has to work with winners and losers and that's just part of the deal, but I think it's wrong that Wellmark can drop people with this excuse, when we are not allowed to know the amount the company really made over the past 3 years.  It's very frustrating.  No other business operates this way.  I don't know what I will do, I already pay $1232 a month with a $3600 deductible. I am retired, and I have a health condition due to radon poisoning.   One of my medications is very expensive.


Megan S. - Readlyn, IA- July 25, 2017

Dear Insurance Commissioner Ommen,

I am a healthy 28 year old farm wife and mother of two and will be unable to purchase health insurance in 2018 unless the stopgap plan is put into place. We work hard and run our business honestly, and it is very upsetting that I cannot buy health insurance as a contributing citizen of this country. We want our voices to be heard once and for all. Please help make things right for the time being while a long term solution is worked on.

Sincerely,
Megan S.


Tom H. - Clear Lake, IA - July 25, 2017

Dear Insurance Commissioner Ommen,

I am a 61 year old retiree with a pre-existing condition and the financial ability to buy health insurance. All I need is a good product to be able to buy. Ideally this would include out of state coverage availability. I agree that a reinsurance policy is a good solution. I am a lifelong Iowa resident and would like to keep  it that way but am currently considering moving out of state just to get health insurance. Please get the stopgap (or something) implemented for 1/1/2018 so I can remain an Iowan.

Sincerely,
Tom H.


Linda K. - Washington, IA - July 25, 2017

Dear Insurance Commissioner Ommen,

I will be 65 in February so this "Iowa Stopgap Measure" will be very important to me for the month of January. Please approve this measure. These high premiums have got to stop.

Sincerely,
Linda K.


Mary Jo M. - North Liberty, IA - July 25, 2017

Dear Insurance Commissioner Ommen,

I have faithfully complied with all the rules and regulations with the train wreck called Obama Care and now another slap in the face.  I may not be able to buy a health plan at any price.  We do not get any subsidies for my Bronze Plan.  Please bring all out pressure on the federal government that will allow Iowans to buy something they can afford and is tailored for individual needs.

Sincerely,
Mary Jo M.


Sherri I. - Slater, IA - July 25, 2017

Dear Insurance Commissioner Ommen,

I am one of the approximately 72,000 Iowans who may have no viable health insurance option in 2018 unless the proposed "Iowa Stopgap Measure" is approved.  I purchased individual health insurance (via the federal exchange (but without a subsidy) in 2016 and this year (2017) have purchased individual insurance (via Farm Bureau) - again without a subsidy.  (I do not have access to group insurance through an employer and while 'older' I am not yet eligible for Medicare.) As is was, this year I had to change my insurance provider (the other withdrew from the Iowa individual market for 2017) was forced to absorb a 43% premium increase (this was for one of the 'least expensive bronze plans') plus an ongoing high deductible and copays.  While I cannot determine what my premiums will be with the "Stopgap Measure" (my income is slightly >the 400% of poverty level so even with the Stopgap Plan I would not receive a large subsidy), without it and based on Medica's proposed single silver plan option (yet another provider change for me - and this is if they do not still decide to withdraw from the Iowa market completely) and their anticipated 43% increase from their 2017 rates, I estimate my premium will increase another 81% from what I am paying this year (already quite high even for the cheaper bronze plan), will be 2.6 times what I was paying for premiums in just 2016,  and I will have to decide whether I can pay nearly 31% of my gross income (and nearly 40% of my net income) for health insurance premiums alone (and then there will still be copays and deductibles).  Such a high cost for just this one item of my monthly budget would make it very difficult (if not impossible) to meet my other expenses, and I would certainly have little to no funds for 'discretionary spending' to support or try to help grow Iowa's economy.  However, as I know just one accident or one serious illness can wipe out a family's finances (and that medical costs are also the cause of a high number of bankruptcies), foregoing health insurance would also be a frightening decision, so the current problems in finding affordable (or potentially any) health insurance are of critical concern.  Also, if the number of uninsured increases due to lack of affordable coverage (or possible lack of any available coverage), hospitals will incur a large increase in their costs to provide emergency care to the uninsured, which will in turn further increase the costs of healthcare to those who are paying.

As such, I support the proposed "Iowa Stopgap Measure" for 2018, during which time hopefully a more viable long term solution(s) can be devised (either at the federal and/or state level) which will allow individuals such as myself and others to have adequate affordable health insurance/healthcare without having to sacrifice many other aspects of their life in order to do so.

Sincerely,
Sherri I.


Denise B. - Malcom, IA - July 25, 2017

Dear Insurance Commissioner Ommen,

I had heard that many families in Iowa would be losing their individual health insurance in 2018.  I had thought that because I had Wellmark through Farm Bureau that I would be "safe".  I am shocked to learn that I am one of the 6,000 Farm Bureau members for which this will not be true.  For those of us who are self-employed farmers, as well as for those who are small business owners, it is totally unacceptable to realize that we may not be able to purchase health insurance, or that it will be higher priced than it already is.  The fact is that Iowa farmers help to feed not only our country, but the world.  In addition to that, farming is considered a dangerous occupation, and thus, health insurance is valuable to farmers.  Why should they be punished because they do not work for a large employer who provides health insurance.

The idea that 72,000 Iowa families will be affected is unbelievable because no one should be in a situation that they cannot purchase health insurance for their families.  I am a single woman who has always purchased an individual policy through Farm Bureau, ever since I left the employment of a large corporation years ago.  We took out these health plans with the good faith that when it came time to renew, we would have the option to renew our current plan or to be able to change to another plan.  I know how I feel about the situation and I can only imagine how someone with a family to care for would feel at the idea that they may not even be able to purchase health insurance.

I am definitely in favor of this "Iowa Stopgap Measure".  I definitely urge that it be approved as soon as possible.

Sincerely,
Denise B.


Sharon M. - Clive, IA - July 25, 2017

Dear Insurance Commissioner Ommen,

I support the Iowa Stopgap Measure.  I currently have a silver plan with Wellmark and pay $992/ month.  We do not qualify for a subsidy, but do not want to to see the premium costs increase 43% or more for myself or for others.  Or the worse case, not even have the option to purchase health insurance because no company sells it.  I am a 59 year old retired healthy individual and have very little medical expenses.  I could easily pay for my medical expenses and pay less that my current premium, but feel that insurance is still needed for the unknown that could happen (accident, diagnosis, etc,) But at what cost should that be.    There has to be something done quickly.

Sincerely,
Sharon M.


Shane E. - West Des Moines, IA - July 25, 2017

Dear Insurance Commissioner Ommen,

Wellmark is an unethical company using healthcare as a wedge between the people and our government.  They should have consequences for this unethical behavior of discontinuing coverage to thousands of hard working self employed Iowans.

Sincerely,
Shane E.


Alan B. - Diagonal, IA - July 25, 2017

Dear Insurance Commissioner Ommen,

As a self employed farmer, I have carried my own health insurance plans for the past 42 years.  Unfortunately with the changes brought on by the Affordable Care Act, I have had to make changes in my policy to keep premiums afforadable.  Because of these changes, I will be without health insurance in 2018 if support the "Iowa Stopgap Measure" is not approved. Without this plan, many others like me (72,000 Iowans and 6,000 Farm Bureau members) will lose their health insurance.   This stopgap plan allows Iowa to have an option for individual health insurance in 2018 - allowing time for long term solutions to be put in place.

I have also seen the changes from the Affordable Care Act impact my sons who are young farmers.  It is essential that the Stopgap Measure be allowed so long term solutions can be developed and implemented.  Do not fail the Americans our government is charged with protecting; approve the proposed Stopgap measure.

Sincerely,
Alan B.


Richard Z. - Vinton, IA - July 25, 2017

Dear Insurance Commissioner Ommen,

My husband and I are small business owners in the state of Iowa. We have worked hard at it for the last thirty two years only to watch our savings disappear in health insurance premiums paid over the last five years. We both have preexisting conditions and find it difficult to search for a new plan every year. If things don't change we will forced to make the challenging decision of whether one of us will no longer have insurance. We are currently paying $1,700 a month with a $5,000 deductible for each of us, not to mention the $7,000 out of pocket for each also. Our co-pay has doubled and so has prescription drugs. Something needs to be done soon. As we are closing in retirement age we are scared to death all our hard work will have been for nothing. Not only does the Insurance industry need to be revamped but so does the medical & prescription industry as well. Just a thought from another poor helpless voter. Thank you for your time.

Sincerely,
Richard Z.


Seth M. - Riverside, IA - July 25, 2017

Dear Insurance Commissioner Ommen,

I support the Iowa stop gap measure. It is extremely stressful to think that my son and I might not have health insurance next year because blue cross is going to cancel our plan. Please do what you can to make this situation better for my family and thousands of others through out the state. Please approve this stop gap plan right away.

Sincerely,
Seth M.


Janis B. - Ames, IA - July 25, 2017

Dear Insurance Commissioner Ommen,

Please take care of the people in this state that have chosen to start a small business or work in any job that does not provide health insurance to their employees.  Only IF and WHEN all have to pay for their health insurance will they realize how "good" they have it compared to those small business owners who PAY their own way.  Thank you!

Sincerely,
Janis B.


Heather P. - Des Moines, IA - July 26, 2017

Dear Insurance Commissioner Ommen,

I would like to offer my support of the "Iowa Stopgap Measure." I am one of the over 72,000 Iowans who purchases my own health insurance and who is in danger of losing my coverage on January 1, 2018, unless this plan is implemented.

I am a single parent of two boys who has already experienced dramatic increases in my health insurance costs over the past three years, making it very difficult to make ends meet. Fortunately, the "Iowa Stopgap Measure" that the Iowa Insurance Division has put together will give Iowans such as myself the option to purchase more affordable health insurance on the individual market. Iowans need this plan to provide a short-term solution to stabilize the damage done by the Affordable Care Act, and to allow time for long-term solutions to be put in place.

I urge you to please take immediate steps to approve the Iowa Stopgap Plan. Thank you very much.

Sincerely,
Heather P.


Alec A. - Osage, IA - July 26, 2017

Dear Insurance Commissioner Ommen,

Healthcare costs for my wife and I have become outrageous. Our highest expense each month is health insurance. We are both young, healthy individuals who rarely need medical attention. We need help, as do many young farmers, business owners and anyone who has to purchase their own insurance.

Sincerely,
Alec A.


Eden H. - West Branch, IA - July 26, 2017

Dear Insurance Commissioner Ommen,

I am a self employed single mother who buys private insurance for myself and my son through Farm Bureau.  Please do everything you can to stop myself and many others from losing our health insurance.  If I am price gouged on insurance, I will not be able to afford to buy it.  Please do not put my son in this position.

Taking insurance away from American citizens is horrid and ridiculous.  Don't let it become accepted.

Thank you,

Sincerely,
Eden H.


Bob Skow, CEO and Tom O'Meara, COO - Independent Insurance Agents of IA - West Des Moines, IA - July 27, 2017

Click here to view the letter.


Randy V. - Rockwell City, IA - July 27, 2017

Dear Insurance Commissioner Ommen,

I  am  married, self-employed, and I have purchased my own health insurance for years.  The cost has risen to out of control and now we are subject to losing our health insurance completely in 2018 if something isn't done. This is why we support the "Iowa Stopgap Measure". We need you to act to approve this plan!

Sincerely,
Randy V


Diane C. - Griswold, IA - July 27, 2017

Click here to view the letter.


Jeff W. - Council Bluffs, IA - July 29, 2017

Dear Insurance Commissioner Ommen,

I have been purchasing a private health insurance policy through Wellmark of Iowa for 8 years.  The premium increases have been huge and caused the payment of those premiums to take priority over many other things.  It came as quiet a shock that due to a pre-existing condition that re-categorized my policy as ACA, I will not be able to purchase health insurance in 2018.  I realize Medica is selling policies but it appears the rates will be prohibitively costly.  As a result, I support the "Iowa Stopgap Measure".

Sincerely,
Jeff W.


Linda C. - Mount Pleasant, IA - July 29, 2017

Dear Insurance Commissioner Ommen,

I support the Iowa Stopgap Measure for health insurance on the open market.  I have seen my premiums increase to over $750/month during the past 3 years through Wellmark's Farm Bureau plan on the open market for individuals.  This is the cheapest HMO plan with a deductible of $6500 before they pay anything.  It also only covers an emergency visit if I am traveling out of state.  I am retired and I do not qualify for a subsidy.  I fear I will be priced out of the market next year with a 43% increase in premium if there is even a plan offered in Iowa.  Please give me a reasonable option to purchase health insurance in the coming year.   It is so unfair not to be able to shop around for a  reasonable health insurance policy with decent coverage in this state.  I fear I will need to move to another state that I can at least purchase health insurance until I turn 65 in 3 years.  HELP!!!!!

Sincerely,
Linda C., DPT, MBA


Ryan R. - Vincent, IA - July 31, 2017

Dear Insurance Commissioner Ommen,

I'l be 27 at the end of the month. Currently I'm looking at serious like changes just to have insurance come 1/1/2018. I'm considering moving to another state or seeking different employment with group healthcare coverage.  It would also be nice to have the Iowa Stopgap Measure as an option come January.

Sincerely,
Ryan R.


Linda F. - Muscatine, IA - July 31, 2017

Dear Insurance Commissioner Ommen,

I currently have private insurance from the marketplace.  I currently already pay a high premium, but I am thankful to have medical insurance in case of any health issues. I am 60 years old and retired.
If I no longer am able to purchase health insurance I will not be able to afford to go to the doctor if I am sick or injured, since I would not be able to afford the doctor and hospital costs.
We need to work hard to ensure that there is an option of purchasing insurance in Iowa and that it is affordable for all Iowa citizens.
Please help us ensure we will have this option in 2018 and future years.

Sincerely,
Linda F.


Tracey M. - Ankeny, IA - July 31, 2017

Dear Insurance Commissioner Ommen,

I need coverage, it would possibly totally destroy our family lively hood if I don't have insurance and need medical attention. It is sad that the government and insurance industry can't supply the American citizens affordable health insurance.

Sincerely,
Tracey M.


Marcia J. - Winterset, IA - July 31, 2017

Dear Insurance Commissioner Ommen,

I am going to be one of the millions without healthcare coverage for the 1st time in 64 years.   That is pretty pitiful of our government to let this happen.   I've been paying privately for the past 3 years.  Excessive amounts with Obamacare to keep my coverage.  It will be very disappointing  and disconcerting  to be without coverage due to the affordable care act.  Please approve the stopgap plan so I will have coverage.

Sincerely,
Marcia J.


Keith M. - Des Moines, IA - July 31, 2017

Dear Insurance Commissioner Ommen,

I am self employed (sole proprietorship) and have paid for my own health insurance premiums since 1999. I have always used Wellmark but because I chose, in 2014, to use one of their new lower premium policies that provided basically the same coverage that I had had previously but with a much lower premium, I am now considered a "new" customer by Wellmark and am losing my insurance in 2018. I fully support the Iowa Stopgap Measure! I have always purchased my health insurance through an agent, and have never qualified for premium subsidies. Without insurance, I will not be able to afford life saving medications. Please do everything you can to enact this measure so I, and thousands of other Iowans, can purchase health insurance.

Sincerely,
Keith M.


Kellie C. - Tama, IA - July 31, 2017

Dear Insurance Commissioner Ommen,

I support the "Iowa Stopgap Measure". Two years ago in August, I chose to switch employment from the public to the private sector. Having been covered under an employer group plan for 18 years, I then needed to carry my own individual health insurance as it was not part of my employee benefits.

Currently, without this plan, health insurance for myself will no long be available (or will be even more unaffordable) in 2018. This stopgap plan allows more than 72,000 Iowa families to have options for individual health insurance until longer term solutions can be put in place.

It is essential for farmers & small business owners, like myself, to approve Iowa's stopgap plan right away.

Sincerely,
Kellie C.


Daniel P. - Manchester, IA - July 31, 2017

Dear Insurance Commissioner Ommen,

I support the "Iowa Stopgap Measure". Without this plan, health insurance will either not be available or will be even more unaffordable for 72,000 Iowa families including over 6,000 Farm Bureau members in 2018. This stopgap plan allows Iowa to have an option for individual health insurance in 2018 - allowing time for long term solutions to be put in place. Without this effort, insurance will be unavailable for thousands of Iowa's self-employed, small business owners, and farm families, including my own. It is essential to approve Iowa's stopgap plan right away.

Sincerely,
Daniel P.


Linda B. - Des Moines, IA - July 31, 2017

Dear Insurance Commissioner Ommen,

After working at PFG for 31 years, I lost my job when they exited the medical health insurance market, a division I worked in for 26 years. Since then I remained unemployed so that I could care for my mother and keep her in her own home. I have no income. My health insurance coats me over $700 a month, and that's with a $5600 deductible.  I'm 57 years old and need health insurance. My father was agency manager of Polk Co FB for 30+ years. Growing up in an insurance family I can't fathom the possibility that I may not have medical insurance available to me. I am pleading with you to keep insurance available and affordable for Iowans like me.

Sincerely,
Linda B.


Randy B. - New Virginia, IA - July 31, 2017

Dear Insurance Commissioner Ommen,

My family needs your help.  We are some of the 72,000 Iowans that purchase our own health insurance and are going to lose coverage on January 1, 2018.  We are self-employed farmers and have no other options for healthcare for us and our three teenagers.  We have paid our own insurance for over 30 years and are now going to be left out unless something changes.  This is extremely frustrating and very scary!   Please help us to at least have a viable option by approving Iowa's stopgap plan.

Sincerely,
Randy B.


Justin R. - Altoona, IA - July 31, 2017

Dear Insurance Commissioner Ommen,

I purchase my own health insurance policy and will lose my coverage if action is not taken. My insurance rates continue to soar each year and are nearly non-affordable for me.  I have a pre-existing condition (Rheumatoid Arthritis) that was diagnosed in my youth. Without the Affordable Care Act, I may not be able to have health insurance coverage. This would ultimately change my quality of life negatively if I did not have access to affordable health insurance and therefore health care providers. As a young Iowan, I deserve to have a positive quality of life. Please help those Iowans that will be left without coverage. I support the "Iowa Stopgap Measure" and ask that you please approve this plan to ensure that myself and thousands of Iowans aren't left without affordable health insurance options in 2018.

Sincerely,
Justin R.


Abigail K. - Marshalltown, IA - July 31, 2017

Dear Insurance Commissioner Ommen,

This is something that is critical to my husband and I.  We own a small business and have bought our own insurance for twenty years.  I need health care insurance in the year 2018.  Please approve Iowa's stopgap plan so that the thousands of Iowans like me will still be able to purchase health care insurance. Thank you.

Sincerely,
Abigail K.


Kent J. - Hancock, IA - July 31, 2017

Dear Insurance Commissioner Ommen,

Please allow the Iowa Stopgap Measure. My wife and I are small family farmers that are paying nearly  $30,000 a year for health insurance with high deductibles. We can not keep this up very long. And now we are told we could lose this insurance next year. Please do what you can to help us. Thank You

Sincerely,
Kent J.


Jackie S. - Reinbeck, IA - July 31, 2017

Dear Insurance Commissioner Ommen,

I currently have health insurance through Farm Bureau under a Wellmark Blue Cross Blue Shield plan.  I am paying over $1,000 per month for this policy.  I have been informed that as of January 1, 2018 I will lose my insurance.  Something must be done to help me and many others like me who have nowhere to turn for their health insurance coverage.  At age 62 with a chronic illness (rheumatoid arthritis), it is very unsettling to be in this situation.

I encourage you to approve the Iowa Stopgap Measure so that Iowans currently facing the future with no insurance options can rest assured there will be coverage available.

Thank you for your time and consideration.

Sincerely,
Jackie S.


Katherine B. - Honey Creek, IA - July 31, 2017

Dear Insurance Commissioner Ommen,

Like many Iowans, I rely on the individual insurance markets for my health coverage.  I am concerned with the actions being taken in Congress.  My premiums and deductibles are very high but at least I am covered in case of a serious illness or injury.  The talk I am hearing will make it impossible to get individual insurance in the near future.  Please think about the impact your actions will have on Americans in every state of this country.  We are hard working individuals that rely on the individual health markets.  I do not qualify for any subsidies to pay my premiums and do not receive any government aid for health.   Living in a rural area makes access to health care options and insurance coverage at even a greater risk as insurance companies consider leaving the individual markets.  Please look at the people you represent and vote for what is best for the welfare of your constituents.  I want to add my voice to those who support the "Iowa Stopgap Measure".

Sincerely,
Katherine B.


Robert G. - Des Moines, IA - July 31, 2017

Dear Insurance Commissioner Ommen,

My wife is one of the people who may not be able to get insurance next year. Luckily, my my children and I am on a pre-ACA health insurance plan. Please, please, please allow the stopgap plan in Iowa for 2018. This will allow for time to find a good, long term solution.

Sincerely,
Robert G.


Shirley B. - Newton, IA - July 31,  2017

Dear Insurance Commissioner Ommen,

My husband has always been self-employed, forcing me to work full time for 25 years so we would have health insurance.  I retired  early in 2015 before Medicare age so I could spend more time with my grandchildren, travel and volunteer.  My husband is now on Medicare, so I am presently buying my single policy through Farm BUreau. I have had 20% and 48 % premium increases (Wellmark) the past two years which is ridiculous!  We did not qualify for subsidies.  It is getting very unaffordable for our family and everyone else in Iowa.  Something has to be done.  The Stop Gap plan sounds good.  We appreciate the Iowa Insurance Commissioner and everyone else working hard to find lower cost, more affordable premiums for all those 70,000 Iowans who won't have insurance options at year-end.

Sincerely,
Shirley B.


James P. - Waterloo, IA - August 1, 2017

Dear Insurance Commissioner Ommen,

I own a small business and pay for my families insurance.  My wife has MS, and though she is doing well, this 'situation' of insurance coverage is something that with our society should be a 'non issue'.  To have the stopgap will allow, hopefully, the politicians and administrators a flexibility to get something completed to protect our families in this country.  We need to have people do their jobs, which is working for the people, allowing us the ability to do our jobs.  Which is working, supporting ourselves, our communities, and our country.

Sincerely,
James P.


Nick P. - Marshalltown, IA - August 1, 2017

Dear Insurance Commissioner Ommen,

This probably won't get read because clearly you people don't actually care but I'm going to write it anyway.

My wife and I were recently married, bought a new home and were looking forward to starting a family together. I'm in an independent contractor and my wife works for a company that does not provide health insurance. We were looking forward to responsibly starting a family together. However, thanks to years of failed government policy and to ridiculous premium increases this dream is not attainable given the current situation. We work HARD, pay our bills and try to be responsible citizens. We've taken it the shorts year after year and NOW, with no affordable providers in our state we'll be penalized at the end of 2018 for something WE CANT EVEN PURCHASE IF WE WANTED TOO!?! Explain to me how that's even remotely fair? Luckily we are fairly young and healthy and our situation is benign compared to the thousands who will be left with no options but no less frustrating. How you people sleep at night blows my mind! Is it REALLY to much to ask to make sure the population of our state AND country have the healthcare options WE deserve??? With all of the rear ending the middle class has taken of the years, would it seriously hurt to DO SOMETHING that actually BENEFITS the citizens of our great state?? Please, for once, DO THE RIGHT THING for your fellow Iowans!! With so much negativity in our world today, it seems to me a little bit of good would not be so bad.

Sincerely,
Nick P.


Timothy L. Charles - President and CEO, Mercy - Cedar Rapids, IA - August 1, 2017

Click here to view the letter.


Public Hearing from Des Moines - August 2, 2017

Click here to view the letter.


William Z. - Ankeny, IA - August 2, 2017

Dear Insurance Commissioner Ommen,

I retired at age 55 from my employer who was at the time offering health insurance to all retirees.  After 6 months of being retired, I received a notice that my employer was no longer offering health insurance because I could buy it "cheaper on the market place"  WRONG.  Wellmark Insurance through Farm Bureau was much more expensive with premiums $1458 per month with $6500 per PERSON deductible.  This equals $30,500 A YEAR for health insurance before any benefit from the health insurance company.  OUTRAGES!! And now I am getting cancelled for next year due to no provider in IOWA.   I blame Obamacare for this screwed up system, which lead to my employer canceling retiree insurance in the first place.  I would not of stopped working if I knew all of this.   Now what to do????  Go back to work?  Move out of state? Go with no health insurance?  Someone tell me?  I hope Trump cancels all of congress FREE health insurance.  And the governor makes Iowa State workers pay their fair share. vs $0 or $20 a month.  Hard working, non-government workers screwed over.  While government interferes and screws everything up that they are not even a part of.

Please help!!  WE need affordable health care.

Sincerely,
William Z.


Carrie K. - Ames, IA - August 2, 2017

Click here to view the letter.


Gail O. - Pleasant Hill, IA - August 2, 2017

Click here to view the letter.


Ronald J. D. - Clive, IA - August 2, 2017

Click here to view the letter.


Suzanne Herzon, Economist, RN - West Des Moines, IA - August 2, 2017

Click here to view the letter.


Rick D. - Alleman, IA - August 2, 2017

Dear Insurance Commissioner Ommen,

My wife and I are retired but not old enough to go on Medicare.  We have been paying for our health insurance the past couple of years and it is getting more and more expensive.  We are losing our current insurance as Wellmark has decided to pull out of the individual policy market.  Therefore, we will be limited to one option in November.  And, that company has asked for a 43% increase in their premiums.

If that happens, we may not be able to afford insurance in the time of our lives when we may need it most.  Please consider the stopgap plan to help those of us who buy our own insurance.

Sincerely,
Rick D.


Mary C. - Clive, IA - August 2, 2017

Click here to view the letter.


Jeanne E. - Charles City, IA - August 3, 2017

Dear Insurance Commissioner Ommen,

I am a 64 year old registered nurse  who chose to retire at the age of 62, due to my husband being older and retired.  I used my COBRA through work and paid over 800 dollars per month to maintain my BCBS policy.  I have never been without insurance and other than a couple surgeries my claims have been minimal throughout my lifetime.   Recently, in July , I started a HSP with Farm Bureau to continue use of BCBS.  My current premiums are over 902 dollars per month, and my deductible is 6,500.  I am fortunate that we can afford this, and very willing to pay my premiums.  We figured this in to our retirement costs; but now because of the current problems ensuing in the insurance industry, I may be without insurance come the first of the year.  I will have 6 months that I need some coverage, prior to me being on medicare.  From what I read, Medica is still in Iowa, likely to raise premiums by 40 plus percent.  Choices that I have at this time greatly concern me.  Do I go back to work for only 6 months, do I move to a state that still has insurance available?   It is greatly distressing.  I know I am not alone in my concerns.  I feel like the rug is being pulled out from under me.  I sincerely pray that our congress and President can get it together, so citizens like myself and numerous other individuals and families are not left without options.

Sincerely,
Jeanne E.


Scott A. - Thompson, IA - August 3, 2017

Dear Insurance Commissioner Ommen,

I strongly encourage you to support the Iowa Stopgap Measure.  I will be loosing my individual plan in 2018.  This measure would keep me financially protected as I won't be able to afford health insurance if there is a raise in my premium.

Sincerely,
Scott A.


Barry D. - Davenport, IA - August 3, 2017

There is no question that we are headed for a financial cliff at full speed. We need this stopgap option in place to at least slow down the impact.


Keith H. - West Des Moines, IA - August 3, 2017

While I am somewhat relieved that something is being done in the short term to provide an additional, hopefully viable option for those affected by the lack of individual health options in 2018, my real concern is that any solution touted has been a short-term one.  This is a systemic issue that is lacking any long term vision.  Maybe we need to start looking at offering Medicare at a younger age, like 55.  You will make both the individual/group marketplace and medicare pools younger. This issue is beyond political pandering....


Tonja L. - Latimer, IA - August 3, 2017

Please put something in place for the individuals that are under 65. A 43.5% increase with Medica is just not something many of my clients can afford. As an Insurance agent, I am feeling torn, Ethically and Morally. Premium are needing to go down. I would like to eat and still be able to support my family. I am a SINGLE MOM and am trying to figure out if it's best for me to SELF INSURE.  My monthly premium would be $743.00 with a $6400 deductible. I would put out $15K before one thing will was paid with an HSA. This seems like money that will be thrown away, since I am healthy. It might be just as easy to SELF INSURE. Please try to find a solution. I see clients that having to make the hard choice to continue working so they can stay on the group plan. I see people that are having to go back to work just to get group coverage. I see people that are having to ask for part time hours, so they can go to the marketplace and apply for coverage and get subsidy, so that they can afford health insurance. Nothing is working for the healthy. When we look at sky rocketing premium, maybe it's best to put riders back in place. The dental insurance requires waiting periods for crowns and major work, maybe health insurance markets could consider waiting periods for major elective surgeries, like knee/hip/ shoulder replacements, lumbar spinal fusions, prostate removal. Also, the RX prices have skyrocketed. Can regulations be put on the price hikes and loop holes that continue to raise prices? I don't have the answers, but something should be done.


Jill S. - Grundy Center, IA - August 5, 2017

Dear Insurance Commissioner Ommen,

Please pass this stopgap measure.  I will be losing my health insurance at the end of this year due to the ACA.  I have carried my own private insurance since I was 19 years old and now need health insurance due to health issues that have arisen during the 26 years that I have carried and paid for my own insurance policy.  I am not someone who just got sick and now wants insurance, I am someone who has been responsible my whole life by carrying an insurance policy my whole working life.  I was kicked off my parent policy at 19 after I complete a 2 year college degree and have been working full time since but never had an employer who provided insurance.  I was kicked off of a policy with coverage that met my needs and had a decent premium due to the ACA in 2013.  I then obtained BCBS and my premiums have increased each year and are now almost 90% higher than my premium in 2013.  Now I am informed I will lose my coverage at the end of this year.  I am very unsure that I will be able to get any coverage let alone coverage that will fit the needs I have right now.
Please pass this measure immediately to help thousands of other people like myself.
Thank you.

Sincerely,
Jill S.


Jay S. - Knoxville, IA - August 6, 2017

Dear Insurance Commissioner Ommen,

As the owners of a small family restaurant in Iowa, we are part of the many who purchase our own health insurance.  We have watched as our insurance costs have risen year after year to an astronomical amount. Now, if we lose this insurance it could quite possibly mean the end of our business.  My wife and I both work full time and then some at our business.  If either one of us should have to leave the business to get a job where health insurance is provided, that would be the end of our business.  We ask that you please approve the Iowa Stopgap Measure. Small business is vitally important to the state of Iowa.

Sincerely,
Jay S.


Noah Jensen Tabor, Esq. - Government Relations Director for Iowa American Cancer Society Cancer Action Network - August 7, 2017

Click here to view the letter.


Josh C. - Tipton, IA - August 7, 2017

Dear Insurance Commissioner Ommen,

I am concerned that if the stop gate measure does not go through I will be forced to work with the Affordable Care Act and that will increase my rates considerably according to my insurance provider please do not allow this to happen. I have a young family of 6 that is very healthy and my insurance rates are to the point where I cannot afford them with my small business and farming operation This is why I support the stopgap measure please consider it, thank you!

Sincerely,
Josh C.


Brad B. - Rockwell City, IA - August 7, 2017

Dear Insurance Commissioner Ommen,

Obviously, the healthcare debate is still raging and actions in DC are dismal to correct the issues that the ACA has created for people, like myself, that are forced to purchase 100% of our own health insurance. I've seen my premiums skyrocket the past 3 years and now I'm in danger of losing coverage altogether. I honestly don't know how what needs to be done to correct these issues, but at a minimum, the Iowa Stop Gap Measure would keep me from from being fined for not having coverage.

Sincerely,
Brad B.


Phillip H. - Pierson, IA - August 7, 2017

Dear Insurance Commissioner Ommen,

I support the "Iowa Stopgap Measure". Without this plan, health insurance will either not be available or will be even more unaffordable for 72,000 Iowa families including over 6,000 Farm Bureau members in 2018. This stopgap plan allows Iowa to have an option for individual health insurance in 2018 - allowing time for long term solutions to be put in place. Without this effort, insurance will be unavailable for thousands of Iowa's self-employed, small business owners, and farm families, including my own. It is essential to approve Iowa's stopgap plan right away.

Sincerely,
Phillip H.


Jerry W. - Le Mars, IA - August 7, 2017

Dear Insurance Commissioner Ommen,

Our government took the best healthcare system in the world ruined it, and it didn't just start with Obamacare, but that was the final nail.  Therefore, the least you can do it put the Iowa Stopgap Measure in place to help us survive.  What is wrong with you people????  If you and Congress had to buy insurance on the individual market like the rest of us, I'm sure this problem would be fixed immediately.  However, the fat cats in Washington decide to take a month-long vacation while leaving the rest of us to twist in the wind.  Anybody with any common sense or compassion would do everything they can to  get this fixed immediately.  I hope you do that.

Sincerely,
Jerry W.


Kathleen R. - Delhi, IA - August 7, 2017

Dear Insurance Commissioner Ommen,

I am a preschool teacher at a private rural preschool.  When I aged-off of my parent's insurance, I was shocked and frustrated that my insurance buying options were so limited and EXPENSIVE, not to mention the fact that I was forced to purchase a plan through the Affordable Health Care Act, something I did not want to do but was forced to or be penalized.  I support the Iowa Stopgap Measure as a single, 28-year-old who is fully willing to pay for my own insurance (if it were actually affordable, that would be a blessing!) and not rely upon the government to take care of my insurance costs.  I, and many others who farm, are self-employed or whose employers do not offer health insurance would all be grateful for the Iowa Insurance Commissioner to present our needs before the federal government and see the Iowa Stopgap Measure through to fruition so that we would not lose our insurance coverage on January 1, 2018. Thank you.

Sincerely,
Kathleen R.


Kirk L. - Moscow, IA - August 7, 2017

Dear Insurance Commissioner Ommen,

My insurance premiums have gone from $6000 a year to over $15,000 a year.  That premium is only covering myself.  My wife pays $6000 a year for herself.  With a $5000 and a $1000 deductilbe that adds up to $27,000 a year.  I am retired and saved for years just to see it go to insurance premiums.  Since I won't have insurance next year I guess I won't have to worry about it.  i have been with Blue Cross Blue Shield since I was born.  They grandfathered me into a plan after I retired then decided they weren't offering that plan anymore.  But my wife is still on a grandfathered plan that I think is the same plan.  This Obama care has changed everything.  I am required to pay for maternity coverage.  In what real world does that apply to me?  There is no common sense going on here.   I need and want insurance but if I can't get it and it is going to go up at least another 18% this year I really don't want to pay it at all.  Actually, my understanding is that I won't be able to get health insurance next year.  This is absolutely insane.  Don't know what you can do about any of this.  But I feel I shouldn't be forced to buy insurance I don't want.  I should be able to but a policy that will fit my needs at a price that is affordable.  I also want to be able to go to a doctor of my choice.  There is nothing right about this whole health care system.  But I am sure I am not the only one who feels this way.  So if you pass the Stopgap Measure, does that mean my insurance premiums still go up at an astronomical rate?  I don't want Obamacare.  I just want affordable insurance.

Sincerely,
Kirk L.


Anne C. - Williamsburg, IA - August 7, 2017

Dear Insurance Commissioner Ommen,

I support the "Iowa Stopgap Measure".  I am one of those affected by the chance of losing coverage next year.  I had to switch last year from a silver plan to a bronze plan in an attempt to hold down the premium cost to near what it was the year before.  The percentage of cost of the health insurance  to that of our farm income is ridiculous.

When I changed jobs I lost coverage under employer sponsored plan and due to having USED my insurance in the past I was dumped into an ACA plan.  Underwriters did not bother to read letters from my doctors verifying that those issues not longer existed nor were likely to ever reoccur.  There wasn't time between when the letters were FAXed and the agent got a "no" to the application for anyone to have read letters.  Now the company is not even going to issue individual plans unless this measure can be implemented.

For the sake of the thousands of us affected please work hard on this measure.

Sincerely,
Anne C.


Megan F. - New Sharon, IA - August 7, 2017

Dear Insurance Commissioner Ommen,

My husband is a farmer and I am a public school teacher. We have a 9-month old son. It is extremely expensive to add them to my health insurance plan through the school, so they both set up individual health insurance policies this year. In December, we have been told both of those policies will no longer exist due to Wellmark leaving the individual market. My son spent 14 days in the NICU after he was born, and if it wasn't for our Wellmark plan, we would have never been able to afford all his hospital bills (totaling around $100,000). My husband also spent time in the hospital this summer with E-Coli (most likely from his cattle), and we wouldn't be able to afford those hospital bills either if it weren't for his Wellmark plan. We have to decide now whether we want to add them to my health insurance plan through the school (which would be about 1/4 of my monthly paycheck) or go without. We aren't sure of the options we have right now and that is scary, especially with an infant.

Sincerely,
Megan F.


Joy P. - Spirit Lake, IA - August 7, 2017

Dear Insurance Commissioner Ommen,

Please put this into action and create affordable insurance for many of us individual insurance holders who year after year have paid our insurance. My husband and I have always been gainfully employed but have never had insurance provided for us as one of our benefits from our employers. I am self-employed. We budget it out of our paychecks. My parents are farmers, as well as my brothers' families and countless other relatives and neighbors. They are self-employed farmers and on individual plans. Why are we being penalized?

We've always covered our family's insurance on an individual plan. It was quite affordable before the ACA came into play, but it has grown to be more expensive than our mortgage payments. The co-pays are rising and the medical coverage is lacking. It means you don't go in unless it's absolutely necessary. You pay hundreds of dollars a month for something you don't use because you can't afford the bill later.  Now there won't be any options! This is really unacceptable that individual plans are being cancelled in the state of Iowa when many of those individual plans are for individuals who work hard and provide a great service to Iowa.

Please help our family of five with young kids, as well as countless others across the state. We shouldn't have to worry about insurance availability and rising costs. Please make it affordable and available for those of us in Iowa, who work hard to give back to the State every day.

Thank you!

Sincerely,
Joy P.


John H. - Cedar Falls, IA - August 7, 2017

Dear Insurance Commissioner Ommen,

In the past couple years Insurance has become more important to me and my family.  I'm a small business owner I have been diagnosed with Macular Degeneration Already losing the ability to read in one eye I'm very concerned to keep treatments to stabilize my bad eye while watching the other eye so it doesn't spread.  Insurance has been a God send to handle these costs of eye injections.  With insurance companies pulling out of Iowa I'm very nervous about having insurance in 2018.  I'm already spending $1000 a month now and need to have insurance going forward.   Please approve the Iowa stopgap plan to ensure myself and others have the opportunity to buy affordable healthcare in 2018.

Sincerely,
Thank You  John H.


Tim K. - Mapleton, IA - August 8, 2017

Dear Insurance Commissioner Ommen,

As a small family farmer I purchase a family health insurance plan through wellmark for myself and my two adult children that are under age 26.  As it is well known these premiums have skyrocketed my son opted to not have health insurance under my plan and pay the tax penalty because it was too expensive.  My daughter and I still maintained our coverage even though we cannot afford it, with my age and possible age related illness and my obligation to take care of my daughter I chose to pay the extremely high premiums.  It is upsetting to me that all we hear in the media and discussions about health care is about how many people will loose their health care coverage, but no one talks about the responsible working people who have carried health insurance on their families their whole life that are now forced to go without health insurance because of the ACA come 2018, and those who have already chose to not be insured because they could not afford the premiums.  Before the ACA was enacted no one was turned away from getting health care if they went to the emergency room,  granted that isn't a good scenario either but in my mind the 150,000 uninsured that are now insured  could have been getting their basic health issues taken care of but now the over 72,000 responsible working Iowans that would like to have insurance to take care of their families need will be forced to live like the formerly uninsured 150,000 and rely on emergency room visits to get health care.

I could go on and on with my dissatisfaction even anger with how the government has handled the health insurance problem, the issue right now is this stop gap proposal for Iowa.  I have read the proposal and see that it may be a possibility for my family but am still concerned about the costs involved.  We will be forced to only have one option which is the silver plan where at the moment I have the highest deductible to keep my premiums as low as possible I hope the credits given will offset the difference and keep my premiums bearable.

With no other options on the table I guess I hope this stop gap proposal will get approved so my family will have the possibility to have some form of health insurance until this mess gets resolved, and I hope and pray that my family can afford it and or stays healthy if we are forced to go without because of cost or unavailability of a viable plan.

Sincerely,
Tim K.


Manda S. - Nashua, IA - August 8, 2017

Dear Insurance Commissioner Ommen,

I support this plan "Iowa stopgap measure "

Sincerely,
Manda S.


PEGGY HUPPERT, EXECUTIVE DIRECTOR OF NAMI IOWA - August 8, 2017 
On behalf of NAMI Iowa, I am pleased to submit the following comments on the proposed 1332 waiver plan to stabilize the small group and individual insurance markets in our state. NAMI Iowa is our state’s largest organization representing people living with mental illness and their families. Access to affordable and reliable health insurance coverage is an important priority for NAMI Iowa. Adequate and affordable insurance coverage is an essential resource for individuals seeking treatment for conditions such as schizophrenia, bipolar disorder, major depression and severe anxiety disorders such as PTSD. The membership of NAMI Iowa knows first-hand the struggles that have plagued our state’s small group and individual health insurance market in recent years. Although it may be true that the requirements of the Affordable Care act (ACA) have contributed to the significant and growing problems of few competing health plans, escalating premiums, growing deductibles and inadequate provider networks, it is worth noting that these disturbing trends predate enactment of the ACA in the small group and individual market, particularly in the remote regions of our state. These challenges of unaffordable premiums and high deductibles in the individual and small group market are especially challenging for individuals and families living with mental illness. Health plans in this market are largely exempt from complying with the Mental Health Parity and Addiction Equity Act (MHPAEA). The ACA changed that by creating a new standard for Essential Health Benefits (EHB), which includes mental health and substance use disorder benefits as one of the required categories. Equally important, the ACA included a standard for plans to comply with MHPAEA which requires equitable coverage, including barring insurers from imposing separate higher deductibles, cost sharing and durational limits on benefits that apply only to mental health treatment. While NAMI Iowa is pleased that this proposed 1332 waiver does not seek to eliminate compliance with EHB or MHPAEA, it is worth noting that the ACA did bring these improvements to thousands of Iowans. NAMI Iowa appreciates the rationale for this proposal. We remain extremely concerned about the fragility of the small group and individual insurance market in our state. It was certainly concerning that all 99 counties were facing the threat of not having an insurer offering coverage in the individual market. Fortunately, it appears that Medica is stepping forward to make at least one plan available next year, albeit with a proposed 43.5% premium increase. Fortunately, a majority of Iowans qualify for tax credits and thus will be insulated from this proposed premium increase. According to HHS data, 44,193 Iowans (86%) qualified for advanced payment tax credits, while 26,848 Iowans (52%) qualified for plans with reduced cost-sharing. These tax credits and cost sharing subsidies in the ACA are critical to keeping coverage affordable for moderate and low-income Iowans. Still an aggressive effort is needed to stabilize the small group and individual market in our state. It is unfortunate that the current political environment has created such enormous uncertainty around the future of cost sharing reduction subsidies (CSRs). We are hopeful that market stabilization legislation will advance in Congress and improve the situation in our market. NAMI Iowa would like to express the following concerns and make the following recommendations relative to the current 1332 waiver proposal: 1) Cost Sharing Reduction Subsidies Under the proposal, federal expenditures originally designated for advance premium tax credits (APTCs) and cost-sharing reduction subsidies (CSRs) would be used to provide premium tax subsidies that would differ from those provided under the ACA. NAMI Iowa supports the goal of providing additional financial assistance to individuals above 400% of the federal poverty level (FPL). There is concern, however, that under the proposal CSRs would no longer be available to individuals who qualify on the basis of income. CSRs help to ensure that lower-income individuals and families can afford the cost-sharing associated with their plan. NAMI Iowa is concerned that eliminating the CSRs – without providing comparable assistance for low-income individuals – will result in these individuals being unable to afford health insurance coverage and thus become uninsured. NAMI Iowa recommends an effort to ensure that low-income individuals at or under 250% FPL continue to have access to CSR plans, either by redirecting funds in the proposal to ensure this financial support, or by simply allowing plans to be sold as they would have, absent this proposal. At this time Congress and the Administration have not provided continuous funding for the CSRs – currently the Administration is choosing to pay the CSRs on a month-by-month basis. As noted above, Congress is still grappling with efforts to pass legislation to extend the legal authority of CDRs for at least two additional years. Given that CSRs are a major funding source, what happens if there is no permanent CSR funding? 2) Single Plan According to the proposal, only one plan – a “Silver” rated plan with an actuarial value requirement between 68% and 72% -- would be available in the market. On the positive side, this plan would cover all essential health benefits (EHBs) as well as our Iowa state mandates. NAMI Iowa is pleased that the proposal would ensure that silver level coverage is available. At the same time, we are concerned about what specific products and services – particularly those people living with a mental illness – will be offered by the plan. Among the concerns that need to be addressed are: a) Prescription Drug Formularies: It is unclear how robust will the plan’s prescription drug formulary be. In management of benefits, will the plan be allowed to deviate from current EHB standards with respect to drugs that must be covered, both across and within diverse therapeutic classes? Will the plan be allowed to use a single drug formulary across the entire state? If so, who will determine what formulary to use? How will appeals/exceptions process work? b) Network adequacy: What standards will be used to determine the adequacy of the plan’s network? What protections can be provided to ensure that individuals living with mental illness will have access to specialized providers and facilities? Due to these concerns, NAMI Iowa urges you to edit your proposal to make sure there are multiple plan options available to accommodate a diverse range of health care needs, particularly those with a serious or chronic health condition. Increased choice in plan design could also be achieved by allowing plans to be sold as they would have, absent this proposal. 3) Continuous Coverage Requirements The proposed waiver appears to allow any qualified Iowan who wished to do so the opportunity to purchase a plan during the open enrollment period (November 1 – December 15, 2017). Any individual who wished to purchase outside this period must show proof of continuous coverage over the preceding 12 months in order to qualify for a special enrollment period (SEP). NAMI is concerned that this policy could have significant unintended and even punitive results. NAMI Iowa would welcome the opportunity to work with you to ensure policy changes do not impact a patient’s uninterrupted access to health insurance coverage and necessary treatment. For example, the proposal appears to penalize an individual for having a gap in coverage in the last 12 months of even 1 day. It is very difficult for many individuals to avoid such a gap when they are experiencing the various life transitions that would qualify them for a special enrollment period (SEP). Further this policy would appear to penalize an individual who chose to remain uninsured and pay an individual mandate penalty under current ACA law. Assuming that a SEP were allowed, anyone trying to use one (except for birth/adoption) must show proof of continuous coverage for the last 12 months. What is their definition of continuous coverage? Absent more details, we have to assume this means the individual must show proof of having been covered for every single day of the previous 12 months. NAMI Iowa has a number of questions about how this would actually work: • What documentation will be required to show this proof? • Will Iowa require employers and insurers to automatically provide enrollees with such documentation? • What system is Iowa going to set up to receive and process such documentation? • Will there be an appeals process? A one-size-fits-all approach that imposes penalties for any interruption in coverage fails to recognize the many legitimate reasons that patients have coverage gaps. For instance, many people may experience a gap in coverage when they lose their job and, along with it, employee coverage. Gaps in coverage also occur as a result of a divorce or death of a spouse when one spouse is no longer covered on the other’s health plan. Moving from one state to another may result in a gap in coverage. All of these examples – and many others – are common reasons why a person may have an unexpected gap in coverage. Penalties imposed on people in these situations may adversely impact access to care, interrupt life-saving treatment and make insurance unaffordable when they attempt to regain coverage. Gaps in coverage are detrimental to individuals struggling to manage the symptoms of schizophrenia, bipolar disorder or major depression. When that access to treatment is disrupted, the effectiveness of the treatment could be jeopardized and the individual’s chance of survival could be significantly reduced. NAMI Iowa is also concerned that the proposal would require an individual to show proof of coverage before an individual is allowed to enroll in coverage. Restricting SEPs and requiring enrollees to document their eligibility prior to coverage increases the risk of gaps in coverage, which can be detrimental to an individual who needs access to coverage. If the Department were to consider such rules, the policy should provide a review process by which an individual could obtain expedited coverage when medically necessary. We also note that it may be challenging for individuals to obtain the required documentation necessary to qualify for an SEP. For example, employers are not required to automatically provide former employees with documentation of loss of minimum essential coverage (MEC). This makes documentation for qualification under a loss of MEC difficult – particularly if the individual’s loss of employment was not a planned event. The circumstances that can cause an individual (or family) to not have had 12 months of continuous coverage are numerous: • Inability to afford COBRA or marketplace premiums, but with earnings above Medicaid eligibility, • Unaffordable premiums for the Iowa PSM plan that result in forgoing the open enrollment period, or • Someone newly moved to Iowa (or within Iowa) that was unable to sign up for a new health plan in advance of the move to ensure continuous coverage. Due to these concerns, NAMI Iowa recommends that you remove this 12-month requirement of continuous coverage from this proposal and allow those who qualify for a SEP under current federal law, continue to do so. This continued access to SEPs could also be achieved by allowing plans to be sold as they would have, absent this proposal. 4) Income Determinations Under this proposal, the income used to determine tax credit eligibility would be based on 2017 household income. We know that individuals’ income can change throughout the year. For example, as discussed above, an individual may lose their job as a result of an acute episode of a condition such as bipolar disorder. NAMI Iowa urges the Department to include mechanisms to allow individuals who experience a change in income to report that change to the Department to ensure that the tax credits are based on actual income. Further, ensuring that premium support is reflective of actual income could also be achieved by allowing plans to be sold as they would have, absent this proposal. Currently, the calculation of APTC’s better reflect an individual or family’s actual household income. 5) Timing The proposal calls for Iowa to assume a tremendous amount of work – essentially creating a new state-based exchange, calculating tax credits, etc. – before November 1st, less than three months from now. This is an enormous undertaking that may not be possible given the shortened timeframe. Should the Department go forward with its plan – which, in essence would take Iowa out of the ACA federal Exchange and create a new structure within the state – what contingencies would be in place should the ambitious timeframe provided under the proposal fall short? 6) Education and Outreach This proposal calls for significant changes to the Iowa small group insurance market. In addition to the ambitious timeframe to set up this new proposal, Iowa will have to conduct extensive education and outreach within the state to inform individuals about the new proposal and how it differs from the plans provided under the exchange in the past. Should this proposal go forward NAMI Iowa will certainly be willing to provide education and outreach to our members across the state. At the same time, there are concerns that such education and outreach activities would be hampered by the fact that the proposal differs from current law. For example, as discussed previously individuals that have been receiving the CSRs – including 26,848 Iowans – would no longer do so. Further, education of enrollees and potential enrollees would be challenging and would also require coordination with the federal government. For example, the material they make available to consumers – through healthcare.gov and other efforts - would have to provide notice to individuals in Iowa of the differences in plan offerings and benefits. Conclusion Given these concerns, NAMI Iowa would urge the Department to strongly weigh the costs and benefits of implementing this proposal in such a limited timeframe, compared to simply allowing plans to be sold (by Medica) in the way they would have, absent this proposal. As noted above, this proposal was originally crafted at a time when it appeared as though no insurer would participate in the Marketplace in all of our state’s 99 counties. That is no longer the case. Therefore we have time to develop a more thoughtful approach to induce additional health plans into our state – especially while Congress is developing legislation for short-term market stabilization.
Joyce Vista-Wayne, President of Iowa Medical Society - August 8, 2017

Click here to view the letter.


Jessica F. - Maquoketa, IA - August 8, 2017

Dear Insurance Commissioner Ommen,

I support the "Iowa Stopgap Measure" because without this plan, health insurance will either not be available or will be even more unaffordable for 72,000 Iowa families including over 6,000 Farm Bureau members in 2018.

This stopgap plan allows Iowa to have an option for individual health insurance in 2018 - allowing time for long term solutions to be put in place. Without this effort, insurance will be unavailable for thousands of Iowa's self-employed, small business owners, and farm families, including the company that I work for. It is essential to approve Iowa's stopgap plan right away.

Sincerely,
Jessica F.


Dianna W. - Williamsburg, IA - August 8, 2017

Dear Insurance Commissioner Ommen,

I always thought that if I paid my premiums, and kept the same suppliers (Farm Bureau & BCBS aka Wellmark) I would always be able to keep my insurance. Having done just that for 40-plus years, no matter how high the premiums got, I will have no health insurance as of 12.31.2017. We switched to a lower-cost policy in 2014, going from a $2,000/month premium to $1,000/month, for my husband and me, both self-employed electricians. Last year it went back to $2,200/month. (This is a HSA policy-high deductible.)  We were not part of the ACA marketplace buyers; we were just taking advantage of a premium 50% lower. My FB rep advised me in 2014 not to do so, because “this” was going to happen.  (And that begs the question, how did he know?)  Now I am paying a very high price for trying to save a major chunk of money each month because Wellmark and I have no idea who else, is now pulling out of single policy coverage in Iowa.

What are you bureaucrats doing to help the taxpaying middle class?  If your salaries are being paid by the health-care corporations, that fact answers my question, without saying another word. But if your position AND department are funded by we-the-taxpayers, DO SOMETHING to fix the American health-care system! I am only asking you to enact/support/whatever the Iowa Stopgap Measure as a short-term answer, so you or other bureaucrats "in charge of that" can get to the business of fixing things before it gets much later.

(I wonder what your reaction would be if your policy was getting jerked out from under you, as a tax-funded employee, at job performance assessment time. Really think about it. Look for a new job? Let's say you can't move, or arrange transportation, or for whatever hypothetical reason, get another job with health insurance coverage. Or any new job you qualify for does not pay enough to cover all the costs of everyday life in Iowa, including health insurance. So you stick with the same job, but no health care coverage. If you really stopped to think about this, I think you might find it very scary, especially if you or someone in your family has asthma, or clinical depression, or a cancer diagnosis in the past. This is what we are dealing with, out here in the real world. And it is a cold, cruel, world.)

I sincerely have no options for health coverage, except no insurance at all, as of Jan 1 2018. Please keep this in mind when you are "trying to do what YOU believe is best" for the soon-to-be-uninsured citizens of Iowa. And if you have a better idea than this Iowa stopgap measure, I, and the others in the same position, would love to hear your brainstorming.

Sincerely,
Dianna W.


Lynn H. - Boone, IA - August 9, 2017

I ask you to please support the stopgap proposal.  When my husband lost his job in late December 2016, we were faced with paying Cobra premiums at $3, 500  er month or purchasing an individual plan through Wellmark (only plans available) at $1,750 per month since we did not qualify for a APTC. The Wellmark plan was virtually worthless as the individual deductible was over $6,000  and the family deductible was over $12,000.  I don't expect health insurance to cover every last penny of my medical costs; however, deductibles and copays should be more realistic than the above.  And we should have OPTIONS!!!  No one should be forced to purchase a product that does not meet their individual/family needs.


Bethany B. - UNKNOWN TOWN/STATE - August 9, 2017

I am opposed to the Iowa Stopgap waiver For many Iowans, the Insurance Department’s proposal would sharply increase both their insurance premiums and deductibles and other out-of- pocket costs at the point of care. Increasing premiums and deductibles means that people who now are able to get the coverage and care they need will struggle to afford insurance and care, and some will not get it at all. This proposal will eliminate the cost-sharing reductions that nearly 28,000 Iowans relied on in 2016 to make deductibles and other out-of- pocket costs affordable. Their deductibles would go from being in the hundreds of dollars to in the many thousands—roughly $4,000 to $6,000, or even more.  The proposed deductible increases caused by eliminating cost-sharing reductions are simply unaffordable for low- and moderate-income Iowans and should not be adopted.  This proposal will cut financial assistance that now helps low- and moderate- income Iowans afford insurance.  Iowans who now get help with premiums based on the actual cost of coverage will receive flat tax credits that don’t keep up with the cost of their health plans, making insurance far less affordable.  Help with premiums for low- and moderate- income Iowans will be diverted to higher-income Iowans and insurers, taking assistance away from Iowans who are most in need. Payments to insurers to lower their costs won’t make up for higher costs faced directly by Iowa consumers.  The proposal requires everyone to buy a silver-level plan, eliminating all other choices for Iowans who might need a different level plan to best meet their needs.  This proposal requires the state to set up a whole new IT system for determining eligibility and enrollment in just two or three months. This is incredibly risky and expensive, as it took the federal government years and even then there were problems. If it fails, coverage for Iowans will be in jeopardy, and even if it works, there will be a huge cost to tax payers.  Iowa should not move forward with this 1332 waiver, which will increase premiums and deductibles and jeopardize coverage and access to care for people across the state.


Jane L. Y.S. - Unkown City and State - August 9, 2017

I realize that Iowa is in a difficult position with only one provider and that provider increasing rates significantly. The proposed “1332 waiver” is a way of addressing this but for many Iowans this proposal would sharply increase both their insurance premiums and deductibles, along with costs. What will happen to people who now are able to get the coverage and care they need? If we are honest, we know that some people will struggle to get coverage; others will fall in the cracks. This proposal would eliminate the cost-sharing reductions that almost 28,000 Iowans relied on in 2016 to make deductibles and other out-of-pocket costs. Their deductibles would go from being hundreds of dollars to roughly $4,000 - $6,000 dollars or even more. These are our neighbors. This proposal would cut financial assistance that is now helping low and moderate-income neighbors afford insurance. What is also frustrating is that these cuts will be diverted to higher-income Iowans and insurers. Payments to insurers to lower their costs won’t make up for higher costs faced by Iowa consumers. This proposal will lead to the state setting up a new IT system to determine eligibility and enrollment in just two or three months. It took the federal government years and even then there were problems. If the new system fails, coverage for Iowa and will be in jeopardy and even if it works it will come with a huge price tag to tax payers. Please as you review this proposal, do NOT move forward with the 1332 waiver! Please think of Iowans who will end up with increased premiums and deductibles and endanger coverage and access to care for people around the state.


Greg P. - Unkown City and State - August 9, 2017

I'm not confident our representatives in Washington are up to the task of creating an "Affordable Health Care" program. I have no special skills in the industry but I'm motivated to finding a solution. I'd be willing to be on a panel to explore real options.

Background: I'm self employed (real estate agent). Was on a BCBS plan for approx 5 years. The slated premium increase for 2016 would have doubled my premium from the first year on the plan. I opted for Market Place insurance through Coventry. Coventry discontinued the plan in 2017. This year, I started with Aetna, they too will be discontinuing the plan at the end of this year. I heard about access to BCBS through Farm Bureau, but today FB tells me that plan will not be available in 2018.

I've heard about a Doctor (maybe in TX) who has fashioned a health care plan the costs clients under $100/month. Sounds "too good to be true". However, our elected officials are too busy "rattling their sabers" to rule out the possibility of real options.

I've read of other independent contractors who are making arrangements to move out of state so they can have access to insurance. Seems a bit extreme to me, but young people who are self-employed... I can understand their frustration and their flexibility.

I don't want to simply complain. I'd like to help figure something out that will work. Is your office working on a plan? Do you need volunteers?

Thank you
Greg P.


Fred L.Goldblatt D.O. - Cedar Rapids, IA - August 10, 2017

As a physician practicing in Marion, Iowa, I see the pain and fear of hard-working, self-employed patients facing the prospect of no health insurance availability.  I am in support of the proposed Iowa Stopgap Measure and urge your department to continue to seek approval.  Too many people will be hurt if the U.S. Administration continues to destabilize the insurance market.  I have friends in Cedar Rapids who will be negatively affected unless we get the approval for Iowa Stopgap Measure.


Nancy K. - Bellevue, IA - August 10, 2017

This is result of government involving itself in what it should have never gotten involved with in the first place, health insurance. The company I have now has asked the state of Iowa permission for a 43% rate hike for 2018. This is not affordable, and the way it stands now,  I will be forced to drop health insurance for 2018.  This year alone, I have already cancelled doctor's appointments, as we cannot afford the health care costs hitting the sky-high deductible as it is. Fortunately both my husband and I have already prepaid our funeral expenses, every single item, even our cemetery marker,  is paid for or covered for my death in the event that we cannot afford insurance to pay for any so-called catastrophic health care for me.  My spouse is luckily on Medicare, I am not.  For a supposedly wealthy country that boasts about having world-class health care, what  will this wonderful health care  do for those of us who cannot afford it?  Shameful!


Michael T. - Unkown City and State - August 10, 2017
Dear Commissioner Ommen, I write in opposition to the proposed Iowa Stopgap Measure Plan. Under the Stopgap proposal, the Advanced Premium Tax Credits and Cost Sharing Reductions (CSR’s) that make health insurance affordable to low and moderate-income consumers would be redirected into a high-risk reinsurance program and allocated to consumers in a flat amount without regard to their income. Currently, the lower a consumers’ income and the higher their age, the more financial assistance they receive to reduce premiums. If their income is below 250% of the federal poverty level they receive lowered deductibles and co-pays. The Stopgap proposal would allocate a flat amount of assistance to everyone making insurance unaffordable to low income and older consumers. In 2016, nearly 28,000 Iowans relied on the CSR’s make deductibles and other out-of-pocket costs affordable. Their deductibles would go from being in the hundreds of dollars to in the many thousands—roughly $4,000 to $6,000, or even more. You assure Iowa consumers that under the Stopgap proposal, premiums will be reduced but you cannot give assurance to what level or who will be able to affordable them. Clearly financial assistance would be shifted from low income consumers in their 50’s and 60’s to moderate income consumers in their 30’s and 40’s. These changes would be harmful to older Iowans who struggle to afford insurance and care already. Some may find it so expensive they will forgo coverage or care altogether. The Stopgap proposal eliminates choices, requiring everyone to buy a silver-level plan, even though some Iowans might choose a different level plan to best meet their needs. Finally, the Stopgap proposal would require the state to set up a whole new IT system for determining eligibility and enrollment in just two or three months. This is incredibly risky and expensive, as it took the federal government years and even then, there were problems. If it fails, coverage for Iowans will be in jeopardy, and even if it works, there will be a huge cost to tax payers. Iowa should not move forward with this 1332 waiver, which will increase premiums and deductibles and jeopardize coverage and access to care for people across the state.

Jane Hudson, J.D., Executive Director, Disability Rights Iowa - August 10, 2017
Disability Rights Iowa (DRI), a non-profit law center, welcomes the opportunity to provide feedback on Iowa’s 1332 waiver. DRI is the Congressionally-mandated protection and advocacy system for Iowans with disabilities and mental illness. For more than 25 years, DRI has provided information, referral, technical assistance, advocacy and legal representation to Iowans with disabilities or mental illness. DRI also has the federal authority to monitor facilities and investigate allegations of abuse and neglect. DRI has significant concerns with waiver proposal. Under the ACA, in order for a state to be granted a 1332 waiver, it must establish that that the proposed waiver will: • provide coverage at least as comprehensive as that provided under the ACA, • provide coverage and protection against excessive out-of-pocket expenditures at least as affordable as that provided under the ACA, • cover a number of residents at least as comparable to the number covered under the ACA, and • not increase the federal deficit compared to what would occur without the waiver. Iowa’s 1332 waiver proposal clearly does not meet the affordability guardrail, and the state has not provided sufficient information to show that it would meet any of the other guardrails The changes that the state is asking for will make it more costly for Iowans to get insurance and make it more expensive for Iowans to get care. These changes would be harmful especially to lower- and moderate-income Iowans and to older Iowans who already struggle to afford insurance and care. Impact on Premiums, Deductibles, and other Out-of-Pocket Costs: ● The proposal would eliminate the cost-sharing reductions (CSR) for lower-income enrollees, which means out-of-pocket costs would be considerably higher for that population. ● Currently, Iowans get help with premiums based on the actual cost of coverage. Under this proposal, Iowans will receive flat tax credits that do not keep up with the cost of their health plans. Impact on Choice: ● The proposal requires everyone to buy a silver-level plan, eliminating all other choices for Iowans who might need a different level plan to best meet their needs. Demands on Information Technology System: ● This proposal requires the state to set up a whole new information technology (IT) system for determining eligibility and enrollment in just two or three months. This is incredibly risky and expensive, as it took the federal government years to set up a system, and even then, there were problems. If the IT system fails, coverage for Iowans will be in jeopardy, and even if it works, there will be a huge cost to taxpayers. The proposal lacks sufficient information to fully understand the impact of the waiver on consumers, the state’s insurance market, and on the federal deficit. Economic and actuarial data and analyses that are required as part of the 1332 application are not included, and the state has stated that it does not plan to provide this data. Since the stated impetus of the Proposed Stopgap Measure (PSM) – no insurers planning to offer coverage in the individual market in 2018 – have been averted with Medica agreeing to offer coverage in Iowa’s individual market in 2018, Iowa should revise and resubmit the application following statutory requirements for public input and analysis.

Stanley P. - Hubbard, IA - August 11, 2017

Dear Insurance Commissioner Ommen,

I reluctantly support the stop-gap measure. I would prefer that my coverage would not change or my premium not change but that doesn't seem likely either. So I am supporting this stop-gap measure to at least have some opportunity to have coverage as my family is in the middle of some devasting medical bills as my wife is going through cancer. We have always had good coverage and service with blue cross through farm beureu and really hope it can continue.

Sincerely,
Stanley P.


Micki Sandquist, Executive Director - American Lung Association in Iowa - August 11, 2017

Click her to view the letter.


Michael S. - Unkown City and State - August 11, 2017

I think the Iowa Stopgap Measure needs to be reworked so that it does not increase the number of people who are uninsured. Subsidies should be based on income and age so that everyone who currently uses this program can continue to do so. I applaud your efforts to fix the problem, but I believe that the program must better consider the needs of the poor, the disabled, and the elderly. I hope that you will consider these issues in your application. I have poor and elderly parishioners who are dependent on these programs and cannot afford increases in their premiums or decreases in their subsidies due to these changes.


Jessica D. - Unkown City and State -  August 11, 2017

I am opposed to these changes. The Stopgap proposal would allocate a flat amount of assistance to everyone making insurance unaffordable to low income and older consumers. Again, the upper middle class and the rich would be fine and the lower middle class and the poor would be stuck, unable to afford insurance. If they could afford it, the deductibles would be such that they might as well not even have insurance. A simple child's broken arm could bankrupt an average family. This plan is risky and does nothing to solve long term issues with insurance in Iowa. Do not hurt poor and elderly to put in a "solution" that sucks.


Douglas Laird - Director of Wellmark Health Plan of Iowa - August 11, 2017

Click here to view the letter. 


Matthew W. - Ankeny, IA - August 11, 2017

Dear Insurance Commissioner Ommen,

Iowans deserve good health care. Many are happy with the current coverage they have with their insurances. Please allow Iowas to continue to have coverage and to live full healthy lives, able to sleep better and night knowing they and their families are insured!

Sincerely,
Matthew W.


Cynthia B. - Toledo, IA - August 11, 2017

Dear Insurance Commissioner Ommen,

With the high cost of health insurance, I had to keep changing coverages (which gave me higher deductibles and co-pays) to be able to afford some sort of coverage and ended up with the ACA policy.  This policy seems to be high priced and wish I would of stayed with my original Blue Cross Blue Shield policy, especially with a 40 plus percent increase it took in one year!  It's terrible a 63 year old has to work a full time and a part time job, to be able to pay bills and health insurance.

Sincerely,
Cynthia B.


Janice K. - Fairfield, IA - August 11, 2017

Dear Insurance Commissioner Ommen,

I fully support the Iowa Stopgap measure. It would be devastating to so many Iowans to be denied health insurance because they could not afford the premiums. Please approve this Stopgap plan to prevent this from happening. Every person in the US should have health care available to them and their families. Thank you.

Sincerely,
Janice K.


Brendt L. - Greene, IA - August 11, 2017

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James L. W. - Waterloo, IA - August 11, 2017

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Roberta S. - Waukee, IA - August 11, 2017

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Julie K. M. - Floris, IA - August 11, 2017

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Corina I. B. - Ames, IA - August 11, 2017

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Linda T. - Garner, IA - August 11, 2017

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Bill P. - Ankeny, IA - August 11, 2017

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Keven G. - Des Moines, IA - August 11, 2017

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Bob A. - Colo, IA - August 11, 2017

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Jack L. B. - Ames, IA - August 11, 2017

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Randy O. - Ames, IA - August 11, 2017

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Beth V. E. - Washington, IA - August 11, 2017

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Nick A. E. - Washington, IA - August 11, 2017

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Loraine V. - Holstein, IA - August 11, 2017

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Jeffrey V. - Holstein, IA - August 11, 2017

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Allen S. - Fertile, IA - August 11, 2017

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Juanita L. S. - Fertile, IA - August 11, 2017

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Ryan M. - West Des Moines, IA - August 11, 2017

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Nancy M. - West Des Moines, IA - August 11, 2017

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Julie E. - Madrid, IA - August 11, 2017

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Mary E. M. - Dike, IA - August 11, 2017

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Donna C. - Iowa Falls, IA - August 11, 2017

Dear Insurance Commissioner Ommen,

I am 60 years old, have paid too much health insurance increases, and do not want to be left without insurance. Please support stopgap so we are not left without insurance!

Sincerely,
Donna C


Jean C. - Marshalltown, IA - August 11, 2017

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Rick B. - Cherokee, IA - August 11, 2017

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Rachel F. - Spirit Lake, IA - August 11, 2017

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Tracy F. - Rock Valley, IA - August 11, 2017

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Susanne E. - Council Bluffs, IA - August 11, 2017

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Chris G. - Farley, IA - August 11, 2017

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Abigail H. - Farley, IA - August 11, 2017

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Randy H. - Charles City, IA - August 11, 2017

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Alicia M. - Maquoketa, IA - August 11, 2017

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Sue K. - Guernsey, IA - August 11, 2017

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Harlan K. - Guernsey, IA - August 11, 2017

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Gene J. - Emmetsburg, IA - August 11, 2017

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Stu C. - Marshalltown, IA - August 11, 2017

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LuAnn L. - Dallas, IA - August 11, 2017

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Jan G. - Knoxville, IA - August 11, 2017

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Dennis G. Sr. - Knoxville, IA - August 11, 2017

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Thomas R. L. - Dallas, IA - August 11, 2017

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Christina B. - Fort Dodge, IA - August 11, 2017

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Jason G. - Bedford, IA - August 11, 2017

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Michael B. - Fort Dodge, IA - August 11, 2017

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Shawn P - Grand River, IA - August 11, 2017

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Jackie K. - Grand River, IA - August 11, 2017

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Lesa S. - Stacyville, IA - August 11, 2017

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Traci G. - Bedford, IA - August 11, 2017

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Kent H. - New Liberty, IA - August 11, 2017

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Benny H. - Dysart, IA - August 11, 2017

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Natalie T. - Cedar Falls, IA - August 11, 2017

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Doug W. - Grandview, IA - August 11, 2017

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Chris E.- Hiawatha, IA - August 11, 2017

I am deeply DISAPPOINTED......there was a hearing in Cedar Rapids last night to hear more about the Stopgap Measure, but I didn't know anything about it.
Where was this advertised?  They showed a snapshot on the local news and there was just a handful in attendance because nobody knew about the hearing.   What a shame!!! (I purchase my insurance from the Federal Marketplace, so this plan will effect me.)
 
The looming crisis in Iowa for "2018"  has ENDED since Medica will sell policies in all 99 counties.  I am GRATEFUL that our new insurance commissioner worked on a plan in case there were no insurers offering a plan.   But, we are no longer in need of the Iowa Stopgap Waiver for " 2018".   If and when there are no insurers available in the future, we could come back to this idea.   Here are the reasons why we should halt this plan for 2018:

1.  There are no cost-sharing reduction subsidies given to the poor to help with their deductible and co-pays.  This money is instead used to give subsidies to the young and higher income individuals and for the reinsurance program.  The lower income individuals will be hurt greatly!

2.  Subsides don't reflect geographic regions which means rural residents pay more.

3. It doesn't utilize the marketplace which makes it easy to file an application and to choose the best option available.  Instead, you fill out an application with each insurance company that you are interested in and wait to find out what the premium may be.  The enrollment period is only 45 days from Nov 1st to Dec 15th.  That sounds like a lot of work in a very small time period.

4.  2018 subsides are used to pay for the administration of this product including verifying income and setting up the reinsurance product.  This means less subsides to the individuals who may need them. 

5.  Many medical associations in Iowa don't support this measure.  Be sure to read all of the comments especially from organizations.

6. Why would Iowa want to waive the ACA's individual mandate which disincentives individuals to purchase  insurance?  If you are young and own no assets, why buy insurance?  This passes the costs on to the insured.


Christine F. - Unknown City and State - August 11, 2017

On behalf of the more than 30 million Americans living with diabetes and the 84 million more with prediabetes, the American Diabetes Association (Association) provides the following comments on the July 13, 2017 version of Iowa’s Section 1332 Waiver Proposal (Waiver Proposal). The Association submitted comments on the initial public draft of the state’s waiver proposal, released June 12, 2017. We appreciate the opportunity now presented by a formal notice and comment period for the version of the waiver proposal submitted to federal officials on July 13, 2017, and respectfully provide these comments on the revised version. Approximately 300,365 people in Iowa, or 11.4% of the adult population, have diabetes. Of these, an estimated 75,000 have diabetes but do not know it, greatly increasing their health risk. In addition, 810,000 people in Iowa, 35.2% of the adult population, have prediabetes with blood glucose levels higher than normal but not yet high enough to be diagnosed as diabetes. Every year an estimated 13,000 people in Iowa are diagnosed with diabetes. Considering this, ensuring Iowa residents with diabetes and prediabetes have affordable access to adequate health care is a key priority for the Association. In our initial comments, we applauded Iowa’s commitment to ensuring the stability of its individual insurance market. However, we noted the state’s waiver application did not meet federal safeguards governing Section 1332 waivers and expressed our deep concern that the proposal, as drafted, would have significant negative effects on the ability of Iowa residents with diabetes to access affordable and adequate health insurance coverage. We continue to appreciate the efforts of Iowa officials to improve the functioning of the state’s individual market, and recognize that ongoing uncertainty regarding federal policy and funding commitments make this task more difficult. Unfortunately, the updated version of the state’s Waiver Proposal does not resolve the numerous substantive and procedural deficiencies of the initial draft, as described in our previous comments. Among these problems: it continues to appear that the state’s Waiver Proposal would leave many Iowans, including older adults and those with lower incomes, worse off than they would be without a waiver. In addition, the state failed to make available in a timely fashion the critical, federally required economic and actuarial analyses that would aid the public and stakeholders in evaluating this important proposal. We therefore respectfully recommend that the state continue to revise its waiver proposal to ensure all Iowans—including the most vulnerable—have affordable access to adequate health care. Thank you for the opportunity to provide additional feedback through a formal public comment period on the proposed Section 1332 Waiver. If you have any questions or need additional information, please contact me. Sincerely, Christine Fallabel Iowa Advocacy Director


Carlisle K. - Unknown City and State - August 11, 2017

As a 54 year old male who has worked in the auto insurance field for thr last 4.5 years, and with my wife and I relocating back to Iowa for family purposes I can see no good coming from such a waiver. I write in opposition to the proposed Iowa Stopgap Measure Plan. Under the Stopgap proposal, the Advanced Premium Tax Credits and Cost Sharing Reductions (CSR’s) that make health insurance affordable to low and moderate-income consumers would be redirected into a high-risk reinsurance program and allocated to consumers in a flat amount without regard to their income. Under the ACA, the lower a consumers’ income and the higher their age, the more financial assistance they receive to reduce premiums. If their income is below 250% of the federal poverty level they receive lowered deductibles and co-pays. The Stopgap proposal would allocate a flat amount of assistance to everyone making insurance unaffordable to low income and older consumers. In 2016, nearly 28,000 Iowans relied on the CSR’s make deductibles and other out-of-pocket costs affordable. Their deductibles would go from being in the hundreds of dollars to in the many thousands—roughly $4,000 to $6,000, or even more. You assure Iowa consumers that under the Stopgap proposal, premiums will be reduced but you cannot give assurance to what level or who will be able to affordable them. Clearly financial assistance would be shifted from low income consumers in their 50’s and 60’s to moderate income consumers in their 30’s and 40’s. These changes would be harmful to older Iowans who struggle to afford insurance and care already. Some may find it so expensive they will forgo coverage or care altogether. The Stopgap proposal eliminates choices, requiring everyone to buy a silver-level plan, even though some Iowans might choose a different level plan to best meet their needs. Finally, the Stopgap proposal would require the state to set up a whole new IT system for determining eligibility and enrollment in just two or three months. This is incredibly risky and expensive, as it took the federal government years and even then, there were problems. If it fails, coverage for Iowans will be in jeopardy, and even if it works, there will be a huge cost to tax payers. Iowa should not move forward with this 1332 waiver, which will increase premiums and deductibles and jeopardize coverage and access to care for people across the state.


Paul O. - Unknown City and State - August 11, 2017

Rather than implement this stopgap measure, please encourage congress to make meaningful fixes to the ACA, that will insure more with robust insurance. If our national congress won't move on it states should consider their own single payer system.

I write in opposition to the proposed Iowa Stopgap Measure Plan. Under the Stopgap proposal, the Advanced Premium Tax Credits and Cost Sharing Reductions (CSR’s) that make health insurance affordable to low and moderate-income consumers would be redirected into a high-risk reinsurance program and allocated to consumers in a flat amount without regard to their income. Under the ACA, the lower a consumers’ income and the higher their age, the more financial assistance they receive to reduce premiums. If their income is below 250% of the federal poverty level they receive lowered deductibles and co-pays. The Stopgap proposal would allocate a flat amount of assistance to everyone making insurance unaffordable to low income and older consumers.  In 2016, nearly 28,000 Iowans relied on the CSR’s make deductibles and other out-of-pocket costs affordable. Their deductibles would go from being in the hundreds of dollars to in the many thousands—roughly $4,000 to $6,000, or even more. You assure Iowa consumers that under the Stopgap proposal, premiums will be reduced but you cannot give assurance to what level or who will be able to affordable them. Clearly financial assistance would be shifted from low income consumers in their 50’s and 60’s to moderate income consumers in their 30’s and 40’s.    These changes would be harmful to older Iowans who struggle to afford insurance and care already. Some may find it so expensive they will forgo coverage or care altogether. The Stopgap proposal eliminates choices, requiring everyone to buy a silver-level plan, even though some Iowans might choose a different level plan to best meet their needs. Finally, the Stopgap proposal would require the state to set up a whole new IT system for determining eligibility and enrollment in just two or three months. This is incredibly risky and expensive, as it took the federal government years and even then, there were problems. If it fails, coverage for Iowans will be in jeopardy, and even if it works, there will be a huge cost to tax payers. Iowa should not move forward with this 1332 waiver, which will increase premiums and deductibles and jeopardize coverage and access to care for people across the state.


Cheryl F. P. - Washington, DC - August 11, 2017

Families USA is a national nonprofit organization and is therefore not submitting extensive comments in this period when comments are invited from “Iowans” (https://iid.iowa.gov/publiccomments.) Instead, I write to express my concern that there be a full public comment period on this waiver at the federal level. We have serious concerns about whether the Iowa waiver will provide “coverage and cost sharing protections against excessive out-of-pocket spending that are at least as affordable” as the provisions of the Affordable Care Act. Unlike Iowa, other states that are working to launch reinsurance programs are keeping affordability protections for low and middle income consumers intact.

The statute requires a process for providing public notice and comment after an application for a waiver is received by the Secretary. We write to express our expectation that once Iowa revises its proposal in response to comments at the state level and submits its waiver proposal to HHS, the federal public comment process will allow consumer groups and other interested parties to weigh in on issues that remain in Iowa’s submission and that are pertinent to national as well as state policy.

On July 12, Iowa requested that HHS exercise discretion under President Trump’s Executive Order 13765 to depart from waiver requirements. At that time, Iowa noted that it was seeking to avoid a “collapse of Iowa’s individual health insurance market” in which there could be “zero carriers.”  Medica has now announced that it will remain in Iowa’s market, obviating the stated need for emergency relief. The Executive Order allows the Secretary to exercise authority and discretion “to the maximum extent permitted by law.” In this case, the law does not permit the Secretary to waive a transparent process for considering a waiver, the Administrative Procedures Act, nor the provisions laid out in Section 1332 (5)(b) of the Patient Protection and Affordable Care Act.


Andrew B. - Des Moines, IA - August 11, 2017

Dear Insurance Commissioner Ommen,

I am writing today to let you know that I support the "Iowa Stopgap Measure". With tens of thousands of Iowans paying for individual healthcare (including myself, a self employed pastor and my wife as an operations manager for a small business) we need affordable options. Until a long term solution can be put in place we need available coverage options. Please do what you can to approve this right away.

Thank you!

Sincerely,
Andrew B.


Sherman N. - Greene, IA - August 11, 2017

Dear Insurance Commissioner Ommen,

I support the "Iowa Stopgap Measure".
As a small family farmer I will have no option for health insurance for 2018. The Stopgap measure is the only possibility for a health insurance plan to be available to me next year.
Please act to approve Iowa's stopgap plan to ensure that thousands of Iowans aren't left without health insurance options.

Sincerely,
Sherman N.


Lori S. - Washington, IA - August 11, 2017

Dear Insurance Commissioner Ommen,

I support the "Iowa Stopgap Measure". Without this plan, health insurance will either not be available or will be even more unaffordable for 72,000 Iowa families including over 6,000 Farm Bureau members in 2018. This stopgap plan allows Iowa to have an option for individual health insurance in 2018 - allowing time for long term solutions to be put in place. Without this effort, insurance will be unavailable for thousands of Iowa's self-employed, small business owners, and farm families, including me.   I don't completely understand this plan but it will hopefully be a Band-Aid until a better plan can be implemented and provide relief to thousands of people.  It is scary not knowing if or what type of health insurance I will have in the coming years.  I would like to see this problem addressed ASAP

Sincerely,
Lori S.


Preston B. - Leon, IA - August 12, 2017

Dear Insurance Commissioner Ommen,

I have been paying for my insurance ever since the affordable care act has been in place and since then it has much more then doubled and I have been to the doctor once in the last three years!  Yet I do not want to lose my insurance please act to approve the Iowa stopgap plan so that I can still have insurance in case something were to happen to me in the future.

Sincerely,
Preston B.


Karen N. - Ames, IA - August 12, 2017

Dear Insurance Commissioner Ommen,

I attended the stopgap forum on Wednesday August 2, 2017.  Despite the technical difficulties, I still learned a lot.  I realized that there are individuals/families/self-employed that potentially will be impacted far greater than I.   We need the stopgap option for 2018 as the government works out the health care problem.  I, currently, can't afford an increase in healthcare (I pay over$700/mo for an individual policy) and will have to go without if it does.  (This currently is greater than my mortgage!)

It's very frustrating that for all of my working life (I'm a healthy 54 yrs, now) I have paid health insurance and was healthy and didn't need the insurance.  Now as I'm approaching the my golden years and likely to need insurance , health care is not affordable!

Please institute the stopgap measure to allow time for Washington to come up with a healthcare solution.

Thank you.

Sincerely,
Karen N. 


Michal L. H. - Britt, IA - August 12, 2017

Dear Insurance Commissioner Ommen,

I live on a small Pension and a Social Security Check My health insurance premium cost me three quarters of these checks to buy so please help in getting affordable health insurance for all Iowans it is so very much needed. THANK YOU

Sincerely,
Michael L. H.


Rose D. - Amana, IA - August 12, 2017

Dear Insurance Commissioner Ommen,

Iowans need a plan to secure insurance for those buying individual plans.  I support the stopgap measure to help Iowans keep their health insurance. This is a n important safety net for me.

Sincerely,
Rose D


Dave S. - Unknown City and State - August 12, 2017

This is a risky last ditch effort, that would still leave many Iowans unable to afford healthcare insurance. Iowa rushes into these programs without any concerns about how successful it might be. Prime example is privatization of Medicaid. This problem still costs Iowans more to get less.


Ronald D. - Unknown City and State - August 12, 2017

My wife and I support this common sense stop-gap plan. We are cautiously optimistic that along with support from both Senators, the Governor and the public that the Federal Government will approve this well thought out plan. Thank you, Mr. & Mrs. Ronald J. D.


Colin S. - Unknown City and State - August 13, 2017

(Submitting on behalf of Young Invincibles -- www.younginvincibles.org) As an organization committed to expanding economic opportunity for young adults, Young Invincibles is gravely concerned about the Iowa Stopgap Measure, the state's 1332 waiver proposal, because it fails to adhere to statutory guardrails outlined in the Patient Protection and Affordable Care Act. First, Iowa proposes to reduce the premium tax credits many low- and middle-income Iowans now receive – and which young adults disproportionately qualify for – in three ways. First, ACA premium tax credits are not available to anyone with income of more than 400 percent of federal poverty, or about $48,000 for an individual. Iowa proposes eliminating the income cut-off, allowing a person 55 years or older to get $117 per month (according to an example in the application) to help pay their premiums, no matter how high their income. Although we recognize that individuals at higher incomes may also need assistance paying for premiums, this new subsidy for higher-income people would be funded by diverting the funds now available to people with lower incomes. The Iowa Stopgap Measure would also change the ACA's premium tax credits into a flat tax credit available to each enrollee – which would shift financial assistance away from the low-income enrollees (who are eligible for larger subsidies) and to higher-income enrollees. In addition, Iowa proposes using federal premium tax credit and CSR funding to provide millions of dollars in reinsurance payments to insurers, a move that’s unlikely to make up for the higher costs many Iowans will have to pay for coverage. For some context, there are 707,000 young Iowans between the ages of 18 and 34, and 67,000 of those young Iowans are uninsured. Of that cohort, 90%, or 60,000 uninsured young people, earn below 400 FPL. Increasing costs for low-income people in Iowa will make it more expensive for most uninsured young people to purchase coverage. Second, most young Iowans enrolled in the individual market would see their deductibles, copayments, and other out-of-pocket costs skyrocket under the Stopgap Measure, as the proposal would strip individuals enrolled in silver plans (the most popular plan among young adults) of cost-sharing assistance. This would cause deductibles for some Iowans to go from hundreds of dollars to between $4,000 and $6,000 each year. But it's not just those low-income individuals enrolled in silver plans who would see their deductibles go up. Because the proposal would eliminate all plans other than silver plans, those individuals enrolled in gold and platinum plans would be forced into less comprehensive coverage that sticks enrollees with greater out-of-pocket costs. These higher out-of-pocket costs could deter people from seeking the care they need and result in higher health care costs for everyone. Third, the proposal does not meet the requirements of a 1332 application. It lacks sufficient information to fully understand the impact of the waiver on consumers, the state’s insurance market, and on the federal deficit. For example, the application does not say whether the state assumes federal CSR funding would be available to finance the state’s proposal. It also leaves open whether the state would waive the federal individual mandate to have coverage or pay a penalty. Economic and actuarial data and analyses that are required as part of the 1332 application are not included, and the state said it does not plan to provide these data. The application also lacks details such as how much people would pay in premiums and what the standard plan’s cost-sharing charges would be. Beyond the statutory objections, these changes would make health care less affordable and accessible for young Iowans. As a generation going to school or just beginning their careers, young adults cannot afford the higher costs most will be subjected to under this proposal. Additionally, by making it harder for young people to afford coverage, Iowa risks exposing Iowans of all ages to higher health care costs. The Iowa Stopgap Measure would exacerbate problems with Iowa's individual insurance market, not fix them, and it does so while spending millions of taxpayer dollars and shifting financial assistance from low-income Iowans to higher-income Iowans. It must be rejected.


Scott F. - Irwin, IA - August 13, 2017

Dear Insurance Commissioner Ommen,

please support the stopgap measure. I cannot afford to have no insurance at no fault of my own.

Sincerely,
Scott F.


Marvin A. - Sherrill, IA - August 13, 2017

Dear Insurance Commissioner Ommen,

We are in support of the Iowa Stopgap measure for health insurance. We are a farm family paying our own individual health insurance. So we need the insurance and we need your support to buy health insurance. Please work to get permanent coverage in place for Iowans who have their own health insurance coverage.

Sincerely,
Marvin A.


Jeanne R. - Ames, IA - August 14, 2017

This is a measure that must be passed for the State of Iowa. Please look at the people who must have this to survive and remain residents of Iowa.


Beth B. - Story City, IA - August 14, 2017

We must approve something for the people of Iowa. For them to be without a coverage option or to face the increased cost of high cost insurance is absurd. This is America, where things like this are suppose to be available!


Clotilde T. - Ames, IA - August 14, 2017

Please support the Stopgap measure.


Tracy K. - Cedar Rapids, IA - August 14, 2017

Dear Insurance Commissioner Ommen,

Yes, I support the Iowa Stopgap Measure for health insurance relief.

As employees of a small business with no employee insurance, we have struggled with insurance premiums since the "Affordable" Health Care Act was enacted.  We started 2014 with two adults age 53, at 16 year old, a 15 year old, and an 11 year old; our premium that year was ~$6400.  That policy did not meet the AHCA guidelines, and we had to find different insurance for 2015.  We joined Farm Bureau to get a better rate on Wellmark, and our premium for 2015 ~$15,500 (which did include a small premium for Delta Dental insurance, as well).  Our insurance rates continue to increase - this year we are paying over $22,300 for health insurance premiums (not including dental), a 44% increase over two years ago.  Morgan is paid well enough that we do not get subsidies. If there is only one company offering insurance in Iowa, I expect the same coverage to cost us over $30,000 for 2018.  This is not sustainable.

We believe the Stopgap Measure, as it is currently written, will be a sufficient short-term solution to get Iowa through another year of this disaster.  Please approve it as soon as possible.  Thank you for your consideration.

Sincerely,
Tracy K.


Tracie F. - Panama, IA - August 14, 2017

Dear Insurance Commissioner Ommen,

My husband and I are small business owners in a small growing community here in Iowa.  We are healthy but our insurance premiums rise and rise each year.  Its hard to make ends meet and pay for health insurance for our family when the cost of insurance is roughly 1/3 of my salary.  We cannot loose coverage in 2018!  You cannot let this happen to Iowans!  If I loose my health coverage I will no longer be able to work for our family business, I will be forced to leave and find employment when I can get health insurance.  Frankly finding a job in these times with good health insurance is not easy.

Please do not allow this gap to happen!
Thank you for your time

Sincerely,
Tracie F.


Jan B. - Ankeny, IA - August 14, 2017

Please support these stop gap measures to retain insurance coverage for Iowans.  It is absolutely critical that this be allowed giving Congress more time to find a more permanent solution.  We can't leave all these people without coverage.  That would not only be mean and unsympathetic,  but it would also not represent who we are.  We care about others who are in need.. 

Thank you,
Jan Brown


Daniel Royer, Vice President, FInancy Policy for Iowa Hospital Association - August 14, 2017

Click here to view the letter.


Stacy Frelund, Iowa Government Relations Director for American Heart Association - August 14, 2017

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Daniel Hoffman-Zinnel, Executive Director, One Iowa - August 14, 2017

Click here to view the letter.


Scott W. - Pacific Junction, IA - August 15, 2017

Dear Insurance Commissioner Ommen,

I certainly hope you people will act now instead of waiting to react when it is too late. I am a healthy 60 year old  male  with  zero health issues. Our fine government decided to mess with the health care program and increase my insurance so as to subsidize everyone that isn't in the healthy shape I am. This is I am very sure,. the same way that millions of hard working older people feel.  I am a small business owner who can't see why 8 years ago my premium was $460.00  a quarter and now ballooned to $891 per month!!!    UNBELIEVABLE!  I  am quite sure if this had taken place with you people, the reaction time would not have taken 8 years to see the problem that was created. My god get on the ball and do something!  Come out in the real world and see what has happened.   I am so sorry for the terrible burden this has placed on families and the not so fortunate individuals of all ages!!

Sincerely,
Scott W.


Jayne M. - Ames, IA - August 15, 2017

The stop gap measure for insurance is needed. Little ones and their families are going through more than just the bodily trials. Insurance shouldn't have to be at the forefront of their struggles. Thank you for your support of this important legislation.


More comments avaialble at https://iid.iowa.gov/proposed-stopgap-measure-public-comments-page-2

More comments avaialble at https://iid.iowa.gov/proposed-stopgap-measure-public-comments-page-3