Here’s an inside look at the federal payments that Iowa insurers are receiving through Obamacare, and how they’re using them.

For the first time, health insurers in Iowa are getting a clear picture of how two of the so-called “three R’s” — the reinsurance, risk adjustment and risk corridor programs — are playing out.

In Iowa, seven insurers that were eligible for payments collectively received more than $54 million in reinsurance payments, which were funded by government fees imposed on the insurers under the Affordable Care Act.

Wellmark Blue Cross and Blue Shield received about $14.3 million between its HMO and PPO plans, while Coventry got approximately $13.4 million. The single largest reinsurance payment, nearly $25 million, was paid to the failed CoOportunity Health.

Iowa Insurance Commissioner Nick Gerhart said that the $25 million reinsurance payment to CoOportunity will be applied to reduce the more than $100 million that has been paid out to date by the Iowa and Nebraska insurance guaranty funds to pay providers for claims that had been filed but were not paid by the failed insurer.

In the risk adjustment program, Coventry apparently had the lowest risk relative to its peers, which resulted in it paying out more than $9.2 million.  

Wellmark’s HMO plan, Wellmark Health Plan of Iowa, will pay out about $2.5 million in risk adjustment dollars to competing carriers. However, the PPO, Wellmark Inc., will receive approximately $4.6 million.

“The data released today confirms that members in Wellmark’s ACA plans were riskier than the average Iowa ACA customer,” Wellmark’s chief financial officer, David Brown, said in emailed comments. Wellmark had earlier prepared a white paper explaining the adjustments.  

“The funds that Wellmark will receive go directly back into paying for the health care services for our ACA members,” Brown said. He added, “When we determined our proposed rates for the ACA individual market, we included assumptions based on what we thought our reinsurance and risk adjustments would be. Today’s numbers are close to what we expected to receive.”

The former CoOportunity Health will receive $7.6 million in individual market risk-adjustment money, which will be paid to the Iowa State Guaranty Fund.

Gerhart said he believes most carriers had an accurate estimate of how much their reinsurance outlays or receipts would be. He said he has not had any comments from carriers since the numbers came out Tuesday.

“The reinsurance was a number that most carriers had modeled out,” he said. “The CoOportunty (reinsurance) number was about spot-on. The risk adjustment, on the other hand, was always a little bit fuzzy (for insurers to estimate).”