The collapse of Iowa’s health insurance exchange could leave more than 70,000 people with no way to purchase individual policies for 2018.

More than half the Iowans at risk of becoming uninsured would have qualified for some services under the Iowa Family Planning Network. But our new state-run family planning program–created at great expense because Republican lawmakers and the Branstad/Reynolds administration insisted on defunding Planned Parenthood–won’t be able to accommodate an influx of patients who had been on the exchange.

State Senator Janet Petersen was one of the panelists at a May 22 event to discuss health care policy in Des Moines. The main focus for Iowa Insurance Commissioner Doug Ommen, former State Senator Jack Hatch, and several Democratic lawmakers was the looming threat to Iowans who now purchase insurance from one of three companies that will exit our market next year.

When it was her turn to speak, Petersen connected the dots between this problem and Republicans’ decision to dismantle Iowa’s Family Planning Network. You can listen here:

First, Petersen pointed out that after June 30, the state of Iowa will be paying the full cost of family planning services for people with incomes below 300 percent of the federal poverty level. Under the system that has worked well for many years, the federal government covered 90 percent of those costs, with Iowa contributing just 10 percent to secure the Medicaid match.

Republicans knew defunding Planned Parenthood would cost ten times more for the same level of family planning services. To pay for the new program, they allocated about $3 million from the already cash-strapped human resources budget.

According to Petersen, about 39,000 of the Iowans who may lose their health insurance in 2018 “would have qualified for at least family planning services” under the network GOP lawmakers “ruined” this year. However, GOP lawmakers capped funding for the new program “at the level of how many people were accessing the service” this year.

Before the Affordable Care Act went into effect, more than 30,000 Iowans were using the family planning network each year, Petersen said. That number had decreased to about 11,000 as many previously uninsured people were able to obtain coverage. But in what Petersen described as a “huge issue,” Republicans didn’t scale up funding for the new program to account for the Iowans who will need family planning services if they lose the insurance policies they have been buying through the exchange.

If Iowa had maintained the current Medicaid waiver for family planning, the state would have had to pay just 10 percent of the extra costs associated with new patients.

Granted, the Iowa Family Planning Network is no substitute for comprehensive health insurance. But the program covers some valuable services for women and men between the ages of 12 and 54:

• Birth control exams and advice.
• Limited testing and treatment for sexually transmitted infections (STIs).
• Pap tests
• Birth control supplies for men and women (see page 2).
• Voluntary sterilization for men and women who are over the age of 21
and have signed a valid Sterilization Consent Form.
• Pregnancy tests.

Family planning services provided as part of or as follow-up to a family planning visit are covered. Examples include services such as: colposcopy, repeat Pap smear, drugs for the treatment of STIs and treatment of yeast infections.

This basic care is important not only for low-income patients, but also for public health goals such as reducing unintended pregnancies, limiting the spread of sexually transmitted diseases, and detecting risk signs for cervical cancer.

Petersen repeatedly warned in committee meetings and on the Iowa Senate floor that cutting off funding for Planned Parenthood’s non-abortion services would reduce access to health care. We learned last week that four Planned Parenthood clinics around the state will close soon because of the new policy.

Maybe Iowa’s individual insurance market can be salvaged for 2018. But if the worst-case scenario comes to pass, tens of thousands of people who would have qualified for family planning services will be out of luck, thanks to GOP legislators and Governor Terry Branstad (cheered on by soon-to-be-Governor Kim Reynolds).

Yet another reason defunding Planned Parenthood will be far more costly than Iowa Republicans let on.

P.S.- Insurance commissioner Ommen told the Des Moines audience on Monday that he has been working with federal government officials, lawmakers, and insurance providers in search of a solution for Iowans who don’t receive employer-provided health insurance and don’t qualify for Medicare or Medicaid. But in his view, a fix requires action by Congress.

I’m not betting that the U.S. House and Senate can agree on a bill that would actually solve Iowa’s problem. Although many House Republicans cited our failed marketplace as a reason to pass the American Health Care Act last month, the health insurance industry has said that bill “needs important improvements” to “ensure the private market delivers affordable coverage for all Americans.” Specific features of Iowa’s risk pool make it unlikely that any insurance company will see a way to make a profit here.

Information from the Iowa Department of Public Health’s website on the Family Planning Network that will be discontinued on June 30: