At his town-hall meeting in Guthrie Center, Mr. Grassley got an earful from residents whose premiums have risen and choices dwindled as insurers that offer plans in the state’s ACA marketplace have fled, potentially leaving Iowa without any major companies offering plans in 2018.
The defections have turned Iowa into a poster child for Republicans who assert that former President Barack Obama’s health law has failed and must be replaced.
“Iowa is in a world of hurt, and something has to be done because Obamacare is a total disaster,” said Guthrie County resident Vinita Smith, a Republican retiree who used to work as a clerk in the state legislature.
.. Democrats, meanwhile, argue that Iowa’s coverage gains under the Medicaid expansion that took place under the Affordable Care Act—about 150,000 Iowans were added to the program— could be swept away by the GOP effort to slash billions from the program.
.. Iowa insurers had particular trouble setting up networks with low prices because there are few providers and hospitals to compete against one another in the state’s many rural areas.
Insurers who participated in the Iowa exchange expected to be reimbursed by under what is know as a risk-corridor program set up by the ACA. But Republicans limited funding for the payments, and insurers received a fraction of the money they requested.
Meanwhile, an Obama administration decision to allow states to let people keep insurance plans they already had—even if they didn’t comply with ACA requirements—permitted younger and healthier people to stay on those less-robust plans. That drove older and sicker people to plans that did comply, leaving those insurers with higher costs and heavier financial losses.
.. “The individual market was broken before the ACA