This bill establishes a state-based exchange and creates a state-based exchange fund in Iowa. It defines a state-based exchange as a marketplace operating under the federal Patient Protection and Affordable Care Act. The bill mandates that the commissioner of insurance submit an application for a state innovation waiver by December 31, 2026, and grants the commissioner the authority to create and operate the state-based exchange if the waiver is approved. The state-based exchange fund will consist of appropriated moneys and other lawful funds available to the insurance division, including federal funds, user fees, and grants.

Additionally, the bill stipulates that all documents and information related to the state-based exchange will be confidential and not subject to subpoena or discovery, with certain exceptions for sharing information with other regulatory bodies. The commissioner is also empowered to adopt rules, including emergency rules, to facilitate the implementation of the bill. The bill is considered of immediate importance and will take effect upon enactment.