Ever since The Patient Protection and Affordable Care Act of 2010  — more popularly known as Obamacare or The ACA — was passed, Republicans have criticized the bill and promised that when they gained power they would repeal it and replace it with lower cost, higher coverage programs available to more people.

The Republicans have broken every one of those promises.

They failed at a repeal because a few Republican senators did not have the stomach to remove ACA coverage from their own constituents.

The US flunks in the health care ratings. We pay at least 50 percent more than any other country, while our health outcomes consistently rank below at least 20 other countries. Worse, we still have tens of millions of uninsured.

Given the Republicans’ failure at the national level, they are now attacking state-organized health care. Iowa has joined in. In the state, Republicans did take measures to make Obamacare less attractive and less affordable. As a result, Iowa now has only one company (Medica) providing care on the ACA exchanges. 

Iowan Republican legislators then decided to exacerbate the problem by allowing Iowa Farm Bureau to sell “health plans.” These plans do not count as insurance, so the coverage can be very slight. Popular aspects of ACA, such as no denial for pre-existing conditions and coverage up to age 26, are not regulated. The Farm Bureau hopes to attract healthy people without pre-existing conditions who are willing to pay little for very little coverage. 

In other words, Farm Bureau is skimming the low-cost customers, while Medica, the one company still in the exchange, takes people with pre-existing conditions and will again have to raise its rates. 

The idea of health insurance is that the broader the pool of the insured, the more costs are spread and the more efficient the program can be. When or if any of the Farm Bureau health plan customers become seriously ill, they will find their plan’s coverage completely inadequate and want to switch to Medica. This spells doom for the exchanges.

Despite their repeated promises, the Republicans could not even repeal the ACA directly, so they are doing it through back-door, disingenuous policies. And their promise to replace the ACA? They haven’t even begun to do that. America remain the developed country with the world’s most expensive health care system and the least coverage.