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.

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