This week on Matter of Fact, open enrollment is underway for the state insurance exchanges, and some states are struggling to provide enough options for their citizens. In Iowa, 72,000 residents who are in the exchange have just one provider option, and premiums are up by over 50 percent. Doug Ommen, Iowa’s Insurance Commissioner, joins Soledad from Des Moines for a conversation about why their state wants to pull out of the Affordable Care Act, their plan for a statewide health care system, and what legislative fixes they want Congress to make in order to create access and bring costs down. Then, Sen. Tom Carper (D-DE) joins Soledad in studio to talk about the bipartisan effort to improve the Affordable Care Act . He’s a vocal co-sponsor of the Alexander-Murray bill to stabilize insurance exchanges, Carper outlines the provisions of the legislation and the impact on states. And, former Congressman Patrick Kennedy, a member of the President’s Opioid Commission, sits down with Soledad to discuss what the Commission accomplished, where resources should be channeled, what’s missing in the report, and the funding challenges ahead.