Iowa’s state lawmakers recently advanced a bill that would allow the Iowa Farm Bureau Federation (IFBF) to offer non-ACA-compliant health coverage administered by Wellmark Blue Cross and Blue Shield of Iowa.

“It’s one more state trying to provide options other than an ACA compliant plan to their constituents,” says attorney Christopher Condeluci, a former Republican staffer for the Senate Finance Committee during the ACA’s drafting.

The nonprofit IFBF would be allowed to offer “a health benefit plan…that shall be deemed to not be insurance.” This proposal is described by the IFBF as “a solution for our members and possibly for a larger portion of lowans,” since anyone can join the farm bureau by paying annual dues of $55 or less. The IFBF estimated that 28,000 of its current members could enroll in such a plan.

Some 53,217 Iowans selected exchange plans for this year, according to CMS, and Minnesota-based Medica is the only option in Iowa’s ACA individual-market exchange.

Opponents worry that the proposal might benefit young, healthy lowans with incomes too high to qualify for ACA exchange subsidies, while disadvantaging individuals who are older or have pre-existing conditions.

“The problem is comprehensive health plans will be more expensive for [people with pre-existing conditions]…and people will buy insurance not subject to any state regulation, and that’s a risky thing to do,” Timothy Jost, emeritus professor at Washington and Lee University School of Law, says. “It’s related to the whole association health plan thing. They’re going to be at more risk and it will raise prices for everybody else.”

Robert Laszewski, president of Health Policy and Strategy Associates, says that the country seems to be headed for a two-tiered individual health insurance market in most states: “one tier for the currently healthy and a [de facto] high risk pool in the Obamacare compliant market.”