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SIOUX CITY | Iowans will have fewer choices when it comes to purchasing health insurance after the state withdrew a stopgap measure designed to make Iowa's collapsing Affordable Care Act marketplace more stable and affordable.

Medica is the sole insurer offering individual and family health plans to Iowa's 99 counties in 2018. Woodbury County residents have the option of purchasing a gold, silver or bronze plan from Inspire by Medica.

Adam Kuiken


Adam Kuiken, financial services manager for Siouxland Community Health Center (SCHC), said the network of doctors, clinics and hospitals that the Inspire by Medica plans offer is "more restrictive." The insurer's website states that consumers will have "access to UnityPoint Health doctors and hospitals plus friends."

"If you go to their website, you can't see that network yet today. It doesn't exactly spell out who's all included," Kuiken said. "(SCHC) has affiliations with UnityPoint, but we don't know if we would be included in that network."

Johnny Tureaud, director of patient access and financial services for Mercy Medical Center, said Woodbury County residents will need to rely on their shopping skills when they log on to during open enrollment, which runs from Nov. 1 to Dec. 15. He also urges consumers to take a look at plans that local insurance agents are offering.

"The stopgap was potentially a very good thing, but where we're ending up now is maybe not the best. It's almost like it's going to collapse," Tureaud said of the state's marketplace.

Without the stopgap plan, an estimated 22,000 Iowans are expected to lose coverage in 2018. Those who choose to purchase an ACA-compliant plan from Medica will face higher premiums. Silver level plans from Medica will increase 56.7 percent on average from 2017 rates, according to information filed with the Iowa Insurance Division.

Actions taken by the Trump administration in the run-up to this year's open enrollment, including an executive order that called for an expansion of less regulated insurance plans and the termination of cost-sharing subsidy payments to insurers, have created uncertainty for insurers and confused consumers, according to the Kaiser Family Foundation, a nonprofit organization that focuses on national health issues.

Larry Levitt, the foundation's senior vice president for special initiatives, said during an Oct. 18 web briefing for journalists that insurers are still required to provide reduced deductibles and co-pays for low-income marketplace enrollees.

"The second most important takeaway for consumers is that while insurers are increasing premiums to offset the loss of payments from the federal government, consumers will be mostly held harmless," he said.

Jennifer Tolbert, director of state health reform for the Kaiser Family Foundation, noted that cuts in federal funding for advertising to promote the ACA sign-up effort and grants for "navigators," who offer assistance to those enrolling in the ACA, could further hamper open enrollment efforts.

"Consumers need to hear this information over and over and over again. The cuts to advertising, particularly the lack of TV advertising, means that fewer consumers are going to hear the messages," Tolbert said during the briefing. "Many programs have had to cut back on their available staff, which means there will be fewer appointments and therefore fewer consumers who will be helped during open enrollment."

Consumers who go without health insurance in 2018 face a penalty of $695 for an individual, up to a maximum of $2,085 for a family or 2.5 percent of household income, whichever is higher.

Kuiken said he hasn't sensed any panic or anxiety from residents who've called to schedule an appointment to meet with a certified application counselor at SCHC.

"Hopefully we can get some great communication out that will allow people to get in and change their plan or update it accordingly," he said.


Health and Lifestyles reporter

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