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Iowa Tries To Prevent Health Insurance Premiums From Escalating


President Trump has repeatedly said Obamacare, the Affordable Care Act, should be allowed to collapse. Last week, his administration canceled a subsidy to insurance companies, a move seen as likely to raise the premiums that consumers pay. Some states would like to try their own ways to hold down premiums, but they have had trouble getting permission from the White House. Here's our co-host, Steve Inskeep.


One of the states struggling is Iowa where the insurance commissioner is Doug Ommen.

What is the situation you're facing in the coming year?

DOUG OMMEN: We have seen this problem coming for some time as we've continued to try to address the concerns here in Iowa.

INSKEEP: The problem is insurance companies say they're not bringing in enough money.

OMMEN: For several years, we've been trying to play catch up with increasing rates.

INSKEEP: Not enough younger, healthier people were signing up for insurance. Those are the people insurance companies make money from. And that leaves an older, sicker customer base, which faces an average premium hike of 57 percent in the coming year in Iowa. Some will get a subsidy to cover the increase, but some middle-income people will not.

OMMEN: Two 55-year-olds, as a couple, will be facing premiums that are $33,000 a year.

INSKEEP: Which is why Iowa's Republican state government asked the Republican Trump administration for a waiver. They wanted to offer cheaper plans with less coverage. Now, you could debate whether that is the wisest idea, but the key point here is they wanted to try it, and it hasn't happened.

So the federal government encouraged you to apply for a waiver to come up with fixes, right?

OMMEN: Yes. That did happen.

INSKEEP: And you did come up with a proposal and went to the federal government and asked them for a waiver. What's happened?

OMMEN: It's been a challenge.

INSKEEP: A deadline is nearing. Iowa needs an answer within days, and no answer has come. The Washington Post reported that President Trump personally intervened against granting the waiver for cheaper insurance in Iowa. Iowa's Doug Ommen says he understands the federal government's problem. It's hard to grant the waiver because a failure to do it properly may draw a lawsuit from supporters of the current law.

Given the widespread suspicion that the president would rather have premiums high because he doesn't like Obamacare, he wants it to go away, and he's said again and again he should just see it collapse, do you think the federal government is sincere in wanting to help you?

OMMEN: This is a very hot political issue, and we have received threats of litigation. We've received - I mean, there are people all over the political spectrum that seem to be interested in holding on to the status quo. And I guess I would just suggest to your listeners that the status quo is not working.

INSKEEP: So you're stuck between an administration that doesn't like the law and supporters of the law who are prepared, you think, to sue if you change it, get a waiver in the wrong way, and that's making it very difficult to do anything.

OMMEN: I'm not going to suggest I'm stuck. I'm going to suggest that there are between 18,000 to 22,000 Iowans that are feeling pretty stuck.

INSKEEP: That's the perspective of Iowa's Republican insurance commissioner, Doug Ommen. Now, NPR's Alison Kodjak is with us next. She covers health insurance. How common is this story, that states are asking for waivers to try to bring down rates and they don't get an answer from the federal government?

ALISON KODJAK, BYLINE: Well, it's interesting because, as Doug Ommen said, the federal government actually encouraged the states to apply for waivers. And four or five states have applied. Alaska's was granted, but the others are kind of stuck, as he mentioned. In Oklahoma, they withdrew their waiver application because they thought it was about to be granted. They needed it by late September, and it wasn't. They withdrew it, and the governor wrote a pretty angry letter to the Department of Health and Human Services.

INSKEEP: We asked Oklahoma officials for comment. They didn't want to talk about it further, but they're pretty stark in this correspondence that they feel the federal government let them down. Now, is this part of a broader pattern by the Trump administration, as its critics would suggest, of trying to let rates go up and up?

KODJAK: Well, there's definitely a large group of people out there from health care lawyers to advocates for patient groups to insurers who suspect that and will say so very loudly.

INSKEEP: OK, so given that, as people go into this Obamacare enrollment period in the coming days, we're going to hear of some very big rate increases. Is it going to be fair to say that at least some of the higher rates are because of actions of the current Trump administration?

KODJAK: It's definitely fair to say that some of those rates are the result of those actions, especially this withholding of these cost-sharing reduction payments that I just mentioned. Those are directly raising rates by stopping those payments.

INSKEEP: Is Iowa's health commissioner right that subsidies may protect some people from these rate increases but not all? Some people will be paying 50-some percent more for insurance.

KODJAK: Absolutely. The majority of people who buy insurance on the exchanges will be somewhat protected, if not fully protected, because the government subsidies have to go up along with insurance rates. But anybody who doesn't qualify for a subsidy is going to have to pay full price, you know, a middle-income family. And they're going to see pretty stark increases in their insurance rates if they buy through the Affordable Care Act exchanges.

INSKEEP: NPR's Alison Kodjak, thanks very much.

KODJAK: Thanks, Steve. Transcript provided by NPR, Copyright NPR.

Steve Inskeep is a host of NPR's Morning Edition, as well as NPR's morning news podcast Up First.
Alison Fitzgerald Kodjak is a health policy correspondent on NPR's Science Desk.