Guest Opinion

Wellmark's concerns are premature and misplaced
First, let's make sure health Insurance exchange is effective at achieving goals
By Andrew Cannon, Research Associate

As published in the Monday, Sept. 12, 2011, Des Moines Register

Key provisions of the Affordable Care Act (ACA) are designed to assure competition, affordability and health access for all Americans. When the dominant insurer in Iowa makes noises that could blunt these efforts, Iowans should take note.

This is the potential effect of recent comments by Wellmark’s top Iowa executive (“Wellmark Undecided on Insurance Exchange,” Aug. 31) in stating the company was uncertain whether it will participate in the new health insurance marketplace, or exchange, to be set up by the new law.

The exchange is one of two cornerstone provisions in the ACA to ensure that all Americans can secure affordable health coverage. The expansion of Medicaid to 133 percent of poverty is the other.

Other aspects of the ACA deal with controlling health care costs, improving the quality of health services, and improving health through prevention. But the exchange and the Medicaid expansion demand the most involvement by state government.

The goal of the health insurance exchange is to provide affordable health coverage options to individuals and families with incomes between 133 percent and 400 percent of poverty who cannot secure affordable health care through employment. Recall that the health insurance industry vehemently opposed a “public option” or other approaches that they claimed would undermine the private insurance market.

The health insurance exchange is a compromise between more sweeping reform and a status quo that effectively blocks close to 50 million Americans from health coverage. It keeps private insurers as the providers of coverage for working individuals and families, with government picking up a share of individual or family costs to make that insurance affordable.

As this compromise developed, the private insurance industry insisted upon a mandate for individuals and families to secure health insurance coverage. The most controversial element in the ACA, this mandate addresses insurers’ concerns. They worried that only individuals and families with high medical costs would participate in the exchange and this would make providing coverage unaffordable to the insurance industry. The mandate wipes away that issue.

The ACA permits each state to develop its health insurance exchange and to contour it to its own system.

For an Iowa health exchange to meet the 2014 federal deadline, Iowa lawmakers must create the statutory framework for the exchange before Jan. 1, 2013. Gov. Terry Branstad has not yet proposed specific enabling legislation and a structure for the exchange, but he is expected to do so this fall.

An effective exchange must fulfill two goals:

Set standards that provide affordable health coverage options to Iowans between 133 percent and 400 percent of poverty.

Do so in a manner that permits private insurers to see the benefit of participating in offering coverage.

The recent comments from Wellmark CEO John Forsyth were reported as a potential blow to Iowa efforts to design an exchange. As Wellmark has 70 percent of the current health insurance market in Iowa, the implication drawn is that its potential withdrawal would be disastrous.

Clearly, however, this puts the Wellmark cart in front of the health exchange horse. The task for Iowa lawmakers is to craft a marketplace that attracts consumers and maintains a level playing field for Wellmark and its competitors.

The question is not whether Wellmark will participate, but whether Iowa will put together a health exchange that meets the two goals above, to benefit everyone — not just Wellmark.


is a research associate for
the Iowa Policy Project
part of the Iowa Fiscal Partnership.
a nonpartisan public policy analysis initiative.
Its reports can be found at