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Posted: 2017-10-29T19:00:34Z | Updated: 2017-10-29T19:15:36Z

The debate over health care in America took an improbable twist in March, when a speech at the Rotary Club in Des Moines, Iowa, became a national news story.

Laura Jackson, an executive vice president at Wellmark Blue Cross Blue Shield, was speaking about the future of the Affordable Care Act . The law could do a lot of good by putting health insurance within reach of millions, Jackson explained, but the newly reformed private insurance market simply wasnt working in Iowa.

Wellmark, the states largest carrier, was losing money on the plans it sold under the new laws regulations. The reason, Jackson said, was a problem called adverse selection: too many people with high medical bills and not enough healthy people paying premiums to cover those costs.

To illustrate Wellmarks situation, Jackson pointed to one customer in particular somebody with a genetic disorder whose bills totaled as much as $1 million a month. She had mentioned this previously, going as far back as 2016, when she said the patients ongoing costs were singularly responsible for about 10 percent of the hefty rate increase Wellmark imposed for 2017. But in this instance Jackson was unusually specific. She said it was a teenage boy with a severe form of hemophilia that required expensive specialty drugs.

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Tony Leys, an astute reporter for the Des Moines Register, wrote about the speech, and USA Today republished his article under the headline Iowa teens $1 million-per-month illness no longer a secret . From there the story went viral. Even Teen Vogue had an item about this mysterious Iowa boy forcing Wellmark to pick up $12 million a year in medical bills.

A few weeks later, Wellmark announced that simply raising premiums again for 2018 wouldnt be enough. Convinced it couldnt make money in the market, Wellmark had decided to pull out of healthcare.gov and stop selling new policies to people buying coverage on their own, rather than through employers.

The announcement meant thousands of people would have no insurance options next year. Medica, an insurer that was already offering policies in one part of the state, eventually agreed to fill the void and offer policies statewide. But it set premiums well above what either it or Wellmark had offered previously, citing the same financial challenges Wellmark had.

The bleak outlook for Iowas insurance market stirred up a lot of anger and anxiety among residents. The stories about the teenager also got a lot of attention, especially in Iowas small, tightly knit hemophilia community. But for one couple, the shock was even greater. Based on the details Jackson had disclosed, they realized, the teenager was almost certainly their son.