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For months, officials in Republican-controlled Iowa had sought federal permission to revitalize their ailing health-insurance marketplace. Then President Trump read about the request in a newspaper story and called the federal director weighing the application. Trump’s message in late August was clear, according to individuals who spoke on the condition of anonymity to discuss private conversations: Tell Iowa no. (Eilperin, 10/5)

President Trump told the head of the Centers for Medicare and Medicaid Seema Varma to deny a request from the Republican-controlled state of Iowa to fix their health-care marketplace, according to The Washington Post. According to the Post, Iowa officials sought for months to get federal permission to fix health insurance markets in their state, but they were shut down by Trump administration officials. (Manchester, 10/5)

Obamacare's first open enrollment season under the Trump administration is expected to be a flop — and even the law's most ardent supporters are worried there's little they can do to change that. With less than a month before sign-up begins, the federal government has gutted outreach and marketing, slashed funding to outside enrollment groups and left state officials in the dark on key details. (Demko and Cancryn, 10/5)

Twenty states attribute ObamaCare premium increases next year to uncertainty caused by the Trump administration and Republicans in Congress, according to a new report released Thursday. The report from pro-ObamaCare group Protect Our Care analyzed the 28 states where final, state-approved rates are public and found that 20 specifically cited uncertainty at the federal level for at least part of the reason for increases. (Hellmann, 10/5)

Iowa officials said Thursday evening they still hadn’t heard whether the Trump administration will approve or deny a “stopgap” plan to stabilize the state’s health insurance market, despite a national report that the president told his administrators to reject it. The Washington Post reported that President Trump told a top human-services administrator in August to reject Iowa’s plan. The proposal was made by Iowa Insurance Commissioner Doug Ommen, who is a fellow Republican. It would redirect Affordable Care Act money in a way that Ommen says would encourage more young, healthy Iowans to buy individual insurance policies and would ease risks to insurance carriers. (Leys, 10/5)

Several states have announced rates for health insurance premiums on the Obamacare exchanges for 2018. Topping the list is Georgia, with rates that are 57 percent higher than last year, while Florida said some premiums will be 45 percent higher. (Gorenstein and Kasperkevic, 10/5)

Companies offering insurance on Florida’s health care marketplace are increasing individual premiums by $208 dollars a month on average next year. Why so much? The insurance companies say while Congress hasn’t repealed the Affordable Care Act, or Obamacare, there’s still plenty of political uncertainty around. (Aboraya, 10/5)

More than 426,000 people in Pennsylvania and 295,000 in New Jersey signed up for health-care coverage this year through Affordable Care Act marketplaces. Gov. Wolf recently bragged that the uninsured rate in Pennsylvania is lower than it’s ever been, thanks to the law better known as Obamacare. New Jersey is touting similar results. And in Washington, the latest effort to “repeal and replace” the ACA was defeated without even a vote. (Quann, 10/4)

Vanderbilt University Medical Center is not covered under any individual Obamacare insurance plan in the greater Nashville area for 2018, insurance representatives said Thursday. The academic medical center is not in-network with either Cigna or Oscar Health, the two insurers selling plans on the federally run-exchange in Davidson, Cheatham, Montgomery, Robertson, Rutherford, Sumner, Trousdale, Williamson, and Wilson counties. It's also not available in the companies' off-exchange plans. (Fletcher, 10/5)

Sen. Ron Johnson (R-Wis.) is threatening to subpoena documents from the Office of Personnel Management [OPM] over what he refers to as the ObamaCare “congressional exemption.” Johnson has criticized rules that allow members of Congress and their staff to receive employer contributions toward their ObamaCare health plans. (Roubein, 10/5)