Wellmark Blue Cross and Blue Shield of Iowa remains the dominant player in Iowa's commercial insurance landscape with massive enrollment, but UnitedHealthcare, Anthem and Cigna have made considerable enrollment gains in recent years. On the health insurance exchange, Medica leads Wellmark in enrollment by a wide margin, but both carriers are returning for the 2021 plan year, giving a sense of stability to the exchange. Iowa's Medicaid program, IA Health Link, staggers on through funding issues; it dropped one MCO in 2018 over a financial dispute and picked up another in 2019, as regulators continue to try to tweak the program on the fly.

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