Iowa Gov. Terry Branstad raised the prospect Wednesday of creating an online health insurance marketplace with three other Midwest states.
In a meeting with Quad-City Times reporters and editors, the governor said he plans to speak with the governors of South Dakota, Nebraska and Kansas about the matter.
"It seems to me it would be worth exploring ...," he said.
Branstad has been critical of the Affordable Care Act and its web portal, HealthCare.gov. But unlike some other Republican governors, he compromised with the Obama administration and legislative Democrats to allow for an expansion of Medicaid in the state. He also agreed to have the state partner with the administration on aspects of its online marketplace.
Late last year, Iowa got a $1 million federal grant to begin planning for a transition to a state-based exchange by 2016.
A multi-state arrangement would cost less than going it alone, Branstad said.
He noted the governors of the other states he's interested in are Republicans and that significant Iowa insurers, such as Wellmark Blue Cross and Blue Shield and CoOportunity Health, also sell policies in some of those states.
Sixteen states and the District of Columbia are operating their own online marketplaces, and in many cases, they've seen higher enrollments than states tied to the federal website. The state-based exchanges account for more than 40 percent of the people who have selected private insurance plans thus far.
Some Iowa Democrats initially pushed for a state-based exchange. In fact, Sen. Jack Hatch, D-Des Moines, urged the governor to call a special session in late 2012 to do that.
Hatch is running for governor this year.
The governor said he has spoken with corporate leaders at Wellmark and CoOportunity, a new Iowa insurer that also sells policies in Nebraska. Wellmark is Iowa's largest health insurer and sells policies in South Dakota, too.
CoOportunity CEO David Lyons said the federal system, even with its early flaws, has worked well for the company. It is pleased with its enrollment figures. But he added a multi-state site probably would be a bit more responsive and allow for a greater focus on regional populations.
"We're very much in support of the concept," he said, but added, "it's very, very early."
He said the company would look to policymakers to take the lead.
Traci McBee, a Wellmark spokeswoman, said in a statement:
"Wellmark has long supported health insurance exchange models that allow more flexibility and local control. We are aware of the options Governor Branstad is exploring and would evaluate our participation when more information becomes available. "
Wellmark chose not to enter the Affordable Care Act's marketplace when it opened last October but intends to do so in 2015.