Whether or not Republicans succeed in replacing Obamacare in coming weeks one thing is clear, the Affordable Care Act is collapsing before our eyes. Insurers have been dropping out of the health care exchanges hand over fist and Iowa will likely join other states in having no individual plans available in most of the state.

Medica, a Minnesota-based insurer, released a statement indicating it would likely be pulling out of Iowa, following two other large carriers, Aetna and Wellmark, exiting the state at the end of 2017.

“Without swift action by the state or Congress to provide stability to Iowa’s individual insurance market, Medica will not be able to serve the citizens of Iowa in the manner and breadth that we do today. We are examining the potential of limited offerings, but our ability to stay in the Iowa insurance market in any capacity is in question at this point,” the company’s statement said.

Medica leaving the state could leave 70,000 Iowas without health insurance options in 2018.

Geoff Bartsh, Medica’s vice president, told the Des Moines Register their hands are tied by Obamacare:

Medica would like to see a reintroduction of high-risk pools, to take on patients with histories of particularly expensive health needs. The insurer also wants Congress to reinstate a national “reinsurance” program, which helps shoulder costs when insured patients come down with extremely expensive health problems. Those two measures would help make insurers’ annual costs more predictable, he said.

Aetna announced it would also no longer participate in the Virginia health exchange in 2018.

Health insurance in America is in a sorry state. Democrats putting their head in the sand and acting like the AHCA will be worse than the decimated ACA that couldn’t even bear its own weight for a handful of years is hard to imagine.