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AP Photo/Pablo Martinez Monsivais

Iowa — Exhibit A in Republicans' argument that the Affordable Care Act isn't working — is asking the Trump administration for help as it tries to "avoid a total collapse" of its individual insurance market. And its plan has a few things in common with congressional Republicans' health care proposals — namely, a new system of financial help, which would shift away from older consumers, toward younger ones.

Iowa's insurance regulators released a proposal today that they believe would stop insurers from fleeing the state altogether. But they'd need both money and permission from the federal government to implement it.

Here's what Iowa wants to do:

  • Come up with one plan — and one plan only — for insurers to sell next year in the state's ACA exchange.
  • Rework federal funding to coax younger, healthier people into buying that new policy. Instead of receiving the ACA's premium subsidies, Iowans would get a fixed amount of financial help, based on their age and income. And people would be eligible for that assistance even if they'd be too wealthy to qualify for the ACA's existing subsidies.
  • Beef up an existing program, known as reinsurance, that helps compensate insurers for exceptionally expensive patients.

Why it matters: So far, the Department of Health and Human Services under President Trump has shown little interest in helping to make the ACA work, and that's exactly what Iowa is asking it to do here. But the similarities to the GOP's health care proposals, which would similarly restructure the ACA's subsidies, could make this pitch more attractive in Washington.

Go deeper

Mike Allen, author of AM
1 hour ago - Politics & Policy

Biden's "overwhelming force" doctrine

President-elect Biden arrives to introduce his science team in Wilmington yesterday. Photo: Kevin Lamarque/Reuters

President-elect Biden has ordered up a shock-and-awe campaign for his first days in office to signal, as dramatically as possible, the radical shift coming to America and global affairs, his advisers tell us. 

The plan, Part 1 ... Biden, as detailed in a "First Ten Days" memo from incoming chief of staff Ron Klain, plans to unleash executive orders, federal powers and speeches to shift to a stark, national plan for "100 million shots" in three months.

Off the Rails

Episode 2: Barbarians at the Oval

Photo illustration: Sarah Grillo/Axios. Photo: Jim Watson/AFP/Getty Images

Beginning on election night 2020 and continuing through his final days in office, Donald Trump unraveled and dragged America with him, to the point that his followers sacked the U.S. Capitol with two weeks left in his term. This Axios series takes you inside the collapse of a president.

Episode 2: Trump stops buying what his professional staff are telling him, and increasingly turns to radical voices telling him what he wants to hear. Read episode 1.

President Trump plunked down in an armchair in the White House residence, still dressed from his golf game — navy fleece, black pants, white MAGA cap. It was Saturday, Nov. 7. The networks had just called the election for Joe Biden.

Fringe right plots new attacks out of sight

Illustration: Aïda Amer/Axios

Domestic extremists are using obscure and private corners of the internet to plot new attacks ahead of Inauguration Day. Their plans are also hidden in plain sight, buried in podcasts and online video platforms.

Why it matters: Because law enforcement was caught flat-footed during last week's Capitol siege, researchers and intelligence agencies are paying more attention to online threats that could turn into real-world violence.

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