Minnesota-based Medica announced Monday it plans to sell individual health insurance in Iowa next year.

The company was one of three insurers who sold policies statewide this year and was the last to say whether it would sell policies in the individual marketplace next year.

The others, Wellmark Blue Cross & Blue Shield and Aetna, both announced in April that they were dropping out next year. And Medica expressed doubts it would continue, too.

However, Medica's announcement, on the deadline for filing rate proposals with the state, came late in the day and, the company said, with a recognition of its unique position.

"When you find yourself as the only ones between people getting access to care and people not getting access to care, your view of the situation becomes very different," said Geoff Bartsh, Medica vice president of individual and family business. "We've filed with the intent to provide access to insurance for all Iowans, whether they are farmers, small business owners or other individuals who need coverage."

The decision also came with a request for a hefty price increase. The company said it is asking for an average premium increase of 43.5 percent.

Bartsch acknowledged such a substantial boost would have a "particularly hard" effect on people who do not qualify for subsidies. But he said the individual market still needs reform and the company would work with state and federal officials to provide stability.

It's not clear what effect the filing might have on the Iowa Insurance Commissioner's request that the Trump administration approve a stopgap measure aimed at dealing with what officials called a collapsing individual marketplace.

Iowa Insurance Commissioner Doug Ommen had said last week the plan was the only alternative to an individual marketplace void of choices.

On Monday, he said the state would press ahead with the request, even with Medica's announcement.

"We appreciate and understand Medica's desire to provide coverage in all of Iowa's 99 counties. That is our goal as well," Ommen said. "We are concerned that Iowa has hit a point within our market's collapse that a 43% rate increase will drive healthier, younger, and middle aged individuals out of the market. Iowa's individual market remains unsustainable and needs a fix from Congress."

The state's stopgap plan would allow companies to sell a single, standardized insurance plan, restructure Affordable Care Act subsidies and create a reinsurance pool to help with high-cost patients.

Medica said that "a number of risks" remain with Iowa's market, which is why it is asking for such a large increase.

Already, Wellmark, the state's largest insurer, said it backed the insurance commissioner's plan and would sell policies in the state for next year if the Trump administration were to approve in a timely manner.

The plan was drafted in consultation with Wellmark and Medica.

About 72,000 Iowans were faced with the prospect there would be no insurers to buy coverage from.

Medica was the only company to file papers with the insurance commission by Monday's deadline. The state insurance division will ultimately decide whether to grant the rate increase request.

Last week, Medica said it would sell policies in Nebraska after other insurers had announced plans to drop out.

Insurers have been fleeing Affordable Care Act marketplaces in other states, as they have lost money selling policies to people whose health care costs were higher than anticipated.

In addition, there has been uncertainty about the future of insurance markets, as congressional Republicans have moved forward on a plan to repeal and replace the Affordable Care Act.

In addition, there have been doubts about the Trump administration's commitment to enforcing the requirement that people buy insurance and provide cost-sharing subsidies to help low-income people.

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