Iowa has submitted a plan to CMS to change Affordable Care Act (ACA) regulations in the state, which would create a new reinsurance program, eliminate the metal-tiered benefit structures of ACA plans as well as end payment of cost-sharing reduction (CSR) subsidies to insurers.

HHS Secretary Tom Price, MD, has actively encouraged states to make use of ACA’s state innovation, or Section 1332, waivers, already approving Alaska’s proposal to create a reinsurance program. As summarized by the Washington Examiner, Iowa’s proposal goes much further and if approved, could provide a blueprint for Republican-controlled states to make conservative-minded changes to ACA exchanges and plan.

One of the biggest changes would be to the ACA’s tax credits for people buying insurance through the exchange. Instead of limiting premiums to a percentage of an enrollee’s income, it would be a flat dollar amount based on income and age, which could shift more of the burden of premium hikes onto consumers.

“We went with a flat subsidy, which actually gives every consumer purchasing power,” Iowa Insurance Commissioner Doug Ommen said to the Examiner. "By redirecting those subsidies, we can actually do a better job of bringing rates down from what they otherwise would be to attract other people in.”

Read more about the changes Iowa wants to make at the link below: