Under the Affordable Care Act, states were allowed to create and operate their own marketplace (a State-based Exchange) or a hybrid called a State Partnership Exchange, in which the state runs certain functions.
A State Partnership Exchange allows states to make key decisions and tailor the marketplace to local needs and market conditions. That is the course Iowa has chosen.
In those states that do not establish their own or create a partnership, the federal government is establishing and operating a marketplace. That is the choice Nebraska made.
Iowa and Nebraska also have taken different paths when it comes to Medicaid expansion. Iowa has adopted a modified form of the program set up by the Affordable Care Act, while Medicaid expansion has stalled in Nebraska.
When the health care plan was approved by Congress in 2010, it was assumed that every state would expand the number of eligible Medicaid recipients with a heavy infusion of federal funds. But a court challenge led to states having options, and Nebraska is among at least 21 states that have rejected the expansion, saying it would be too costly.
The Affordable Care Act’s authors had expected Medicaid expansion to extend coverage to about half the number of uninsured people intended to be covered. The law seeks to provide more coverage and more preventive care, resulting in fewer emergency room visits and less catastrophic illness — eventually lowering health care costs.
The gap in coverage in Nebraska puts that goal in jeopardy and likely pinches hospitals such as the Creighton University Medical Center and the Nebraska Medical Center, which will lose some federal money on the assumption that they will be treating fewer uninsured people. The gap could pressure clinics for low-income families, which have more requests for appointments than they can book.
Iowa’s approach to Medicaid expansion calls for those in the program with higher income levels —- 101 percent to 138 percent of the federal poverty level — to enroll in commercial health plans available through the health insurance marketplace. Instead of receiving tax credits, those participants will have their insurance premiums paid by Medicaid.
In the second year, many participants in the Iowa plan will have to pay a monthly premium of up to $10. However, that premium, paid to the state, would be waived by participation in a wellness program that includes an annual physical, a health risks assessment, smoking cessation and other activities. The idea is that participants invest in their own health and have an incentive to stay healthy.
— From healthcare.gov, World-Herald archive