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IA/NE Border: Higher Healthcare Premiums West of Missouri River

PHOTO: On the Iowa/Nebraska border, what you pay for health insurance may depend on which side of the Missouri River you live. That's the finding of a new survey of 16 border counties. Photo credit: Ron Reiring/Flickr
PHOTO: On the Iowa/Nebraska border, what you pay for health insurance may depend on which side of the Missouri River you live. That's the finding of a new survey of 16 border counties. Photo credit: Ron Reiring/Flickr
April 30, 2014

DES MOINES, Iowa - Some live just a stone's throw away from each other, but how much people have to pay for basically the same health insurance policies varies widely across the banks of the Missouri River.


For the platinum level, Iowa border counties had higher average premiums, but Bailey noted that the silver and gold plans under the Affordable Care Act are the most common by far - and also the most important for low- and middle-income families.

Bailey said the differences in premiums can be attributed largely to the Medicaid expansion option under the Affordable Care Act. Nebraska has not expanded its program, while Iowa has decided to cover more of the working poor. That difference changes each state's pool of people eligible for the marketplace.

"So now in Nebraska, you've included those lower-income - and on average, sicker - people in the pool, whereas in Iowa you now have taken them out of the pool and put them in their own program."

In the last two legislative sessions, there have been efforts to expand Nebraska's Medicaid program similarly to those in Iowa, but filibusters have kept the measure from getting to the Senate floor for a vote.

The report, "A Tale of Two States: Insurance Premiums in Border Counties of Nebraska and Iowa," is online at
John Michaelson, Public News Service - IA