Donald Trump’s health secretary was on fire during a March 5 address to the Federation of American Hospitals. Alex Azar, the former Eli Lilly executive now charged with overseeing everything from Medicare to the Centers for Disease Control & Prevention, outlined plans to achieve nothing less than the “value-based transformation” of American health care.

“Today’s healthcare system is simply not delivering outcomes commensurate with its cost,” he said. And Azar put his biggest finger on a commonly blamed problem: the fact that American health care is “paying for procedures and sickness” instead of “outcomes and wellness.”

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New health-insurance legislation in Iowa will become the latest test of the ability of states to allow coverage that doesn’t comply with the federal Affordable Care Act.

Iowa Gov. Kim Reynolds is expected to soon sign into law a bill that would allow the Iowa Farm Bureau, a nonprofit, to offer health coverage that would fall outside the ACA’s rules. The new coverage, which the legislation calls “health benefit plans,” would be administered by the state’s largest insurer, Wellmark Blue Cross & Blue Shield . The product would officially not be considered health insurance, according to the legislation—leaving details of the coverage unclear.

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