IA HSB721

Establishes a state-based health insurance exchange in Iowa operating under the federal Affordable Care Act, with the Insurance Commissioner authorized to create, implement, and administer the exchange at the Governor's direction.

Requires the Insurance Commissioner to submit a state innovation waiver application by December 31, 2026, and if approved, operate the exchange in accordance with the approved waiver.

Creates a State-Based Exchange Fund in the state treasury to be funded through general assembly appropriations, federal government funds, user fees, and grants, with moneys remaining available across fiscal years without reverting.

Designates all documents, complaints, investigations, and information related to the exchange as confidential records exempt from public disclosure, subpoena, and discovery in private civil actions.

Authorizes the Commissioner to share confidential information with other state exchanges, regulatory authorities, law enforcement, and federal agencies if recipients agree in writing to maintain confidentiality, and permits adoption of emergency rules to administer the exchange.