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Dear Ms. Grutz, Thank you for taking the time to contact me about health care reform. It is important for me to receive direct input from folks in Iowa on policy matters such as this, especially when these issues affect people on such a personal level.  Since joining the U.S. Senate, I have had the opportunity to complete three 99 county tours, and have begun my fourth. Throughout my travels across the state, I have participated in roundtables with our local small businesses, toured manufacturing and agricultural operations, visited hospitals, schools, and more. In these meetings, I have heard countless stories from our neighbors from all parts of the state about how they are personally struggling under the Affordable Care Act (ACA), with their premiums and other out-of-pocket costs increasing year-to-year and their choice of health insurance options dwindling. Since last fall, more and more Iowans have shared with me the hardships they are enduring due to the cost of their health insurance, and the difficult decisions they have to face - all because there is only one insurer, Medica, participating in the state's individual market for 2018. Given the state of Iowa's individual market, I joined Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) in cosponsoring their short-term, bipartisan legislation to improve flexibility, expand choice, and help stabilize health insurance markets over a two-year period. Unfortunately, Senate Democrats blocked a vote on this bipartisan proposal.  I am frustrated that Washington has failed to repeal and replace the ACA, and find a pathway forward to ensure affordable and quality health care coverage for Iowans. I am heartbroken over what is occurring in Iowa, as health insurance that is too expensive to use is not health insurance. I remain committed to sending legislation to the President's desk for his signature that repeals and replaces this failed law. Rather than Washington-centric mandates, our health care system should be grounded in affordability, competition, flexibility, and empowering folks to choose the best health coverage for their individual needs.   Additionally, I wanted to share with you that on April 2, 2018, Governor Kim Reynolds signed into law Senate File 2349 to expand health care options in our state and allow Iowans and their families to purchase a health benefit plan. The health benefit plan is not subject to certain ACA regulations and can be a much more affordable alternative. The Trump Administration is also pursuing solutions to reduce health care costs and ensure folks have more choice. As you may know, the Department of Labor issued a proposed rule seeking to expand access to association health plans and the Department of Health and Human Services issued a proposed rule to increase the availability of short-term limited duration plans. The ACA is failing Iowans. I am encouraged by the actions Iowa and the Trump Administration have taken, and I will continue to work toward affordable, patient-centered solutions with my colleagues in the U.S. Senate as well.    It is essential for me to hear directly from folks, such as yourself, with their feedback and personal stories in accessing health care. Thank you again for contacting me about this important issue. Feel free to share with me any further information, as I always enjoy hearing from Iowans. Sincerely, Joni K. Ernst United States Senator