The health insurance marketplace in Iowa is in even more turmoil than usual.

Congress may vote before the July 4th recess on legislation to repeal Obamacare and replace it with a different system.  At the same time, there are a lot of questions about how 2018's health insurance system will work in the state.

Last Monday was the deadline for insurance carriers to file with the State of Iowa their proposed rates for 2018 for individual health insurance policies.  Blue Cross/Blue Shield and Aetna had earlier announced they would be discontinuing offering such policies for 2018.  Medica, a Minnesota-based health insurance company, announced that it intends to stay in Iowa's health-insurance market—but by raising the prices of its health insurance policies by 43 percent.

One other regional health insurance company—Gundersen Health Plan—has merged with Unity Health Plan, also of Wisconsin, to form "Quartz Benefits."  Quartz spokesperson Jennifer Woomer Dinehart says, "We are still working through the decision."  Quartz did not file proposed individual health insurance policy rates with the State of Iowa by last week's deadline.

Iowa's insurance commissioner has proposed a stopgap health insurance marketplace plan.  It would set up a reinsurance program, using $80 million in federal money, which would be paid to health insurance companies to cover the costs of insured people who need more than $100,000 per year in health care.  Such a plan would need federal approval.

Much of the focus about health insurance has been about the price of health insurance policies.  But Benefits Consultant Brian Huinker from Midwest Group Benefits in Decorah says that focus is misplaced: "Until we get a handle on drug and hospital charges, none of this matters.  Costs continue to rise at an unsustainable pace.  We are just kicking the can down the road."