Iowa will probably not attempt to revive its failed Affordable Care Act 1332 waiver and will instead likely approve short-term plans and association health plans, according to the state's insurance regulator.

In an interview conducted during the National Association of Insurance Commissioners' fall meeting, Iowa Insurance Commissioner Doug Ommen questioned whether a waiver would still be "appropriate" in light of recent rule changes by federal regulators.

Iowa in 2017 withdrew its application for a waiver that would allow it to set up a reinsurance program for highest-cost consumers. Just a year later, however, the Trump administration rolled out a slew of new rules for alternative plans and guidance on 1332 waivers, which allow states to operate their own health systems if they can prove it will cost less and cover more people than without it.

Under the new rules, short-term plans can now last up to 12 months, as opposed to just three months, and can be renewed for up to two years. A rule finalized by the Department of Labor in June allows businesses and the self-employed to purchase small-group plans that are exempt from the ACA's essential health benefits requirements.

Ommen said he views Iowa's market as relatively stable because most enrollees in the state are heavily subsidized. He also pointed out that health insurance premium rates have fallen for the sole ACA insurer in the state, Medica Holding Co.

Iowa's insurance department is "making some strides moving forward" with association health plans and potentially short-term plans. Ommen stressed that they would be subject to regulatory oversight over out-of-pocket limits and have other restrictions. He said longer short-term plans could "fill a gap" similar to that of major medical plans.

"But it will require state regulatory intervention. ... We believe that it can be used to benefit Iowans that have been priced out," he added.