In deciding the future of health care coverage, Medica may call the shots

The future of Obamacare is being decided in a back room somewhere in Washington, from what we’ve been told, but maybe its immediate future is being decided in some cubicles in the Twin Cities.

Medica has hung in to health insurance exchanges when bigger companies have pulled out. In many counties, Medica is the only option, Vox notes today. If there’s an Obamacare at all, it’s only because of Medica.

Medica only sold coverage in three Midwestern states before the ACA. It saw the health care law as a chance to break into new neighboring markets.

“It wasn’t until post-ACA that we looked more aggressively for opportunities for geographic expansion,” Bartsh says. “The advent of the exchanges was an easier way to create a distribution channel.”

Medica launched on three marketplaces — Minnesota, North Dakota, and Wisconsin — in 2014. It joined the Nebraska and Iowa marketplaces in 2016 and the Kansas marketplace this year.

Medica, like many of its competitors, has lost money in the Obamacare marketplaces. In 2016 alone, the plan lost $50.6 million in the individual market. But unlike bigger health plans, it remains bullish. Medica has decided to weather the storm and says that in the first quarter of 2017, it’s already seen improvement.

The plan expected to keep adjusting premiums until it got them right, and slowly gain market share. But then other plans started quitting — and now Medica is set to gain market share incredibly quickly.

Medica’s size could explode as other companies pull out. How many Obamacare enrollees can it pick up? What should the premium structure be? How will Trumpcare change the market?

The comparatively small company is holding what’s left of Obamacare together.

And that’s the problem.

In most of Iowa, the Des Moines Register reported in May, Medica is the only company left and it reportedly is considering pulling out if changes aren’t made.

That’s got state official scrambling, proposing age- and income-based tax credits and usuing a reinsurance mechanism for large medical claims, in an effort to prop up the market.

Earlier this year, Medica dropped 300,000 Minnesotans covered by state public health insurance programs. Minnesota politicians agreed to a reinsurance program much like what Iowa is considering.