Earlier this month, the Trump administration shot down a plan from Idaho to sell health insurance that doesn’t comply with Affordable Care Act (ACA) regulations.

“If a state fails to substantially enforce the law, the Centers for Medicare & Medicaid Services (CMS) has a responsibility to enforce these provisions on behalf of the State,” wrote CMS Administrator Seema Verma in her rejection letter.

Three weeks later, another state — Iowa — is on the verge of making a similar move.

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