About a month ago I explained that "we must unite to defend health insurance legislation that is “the craziest thing in the world”, and that sometimes "catches fire", that its premiums rise more than 20 percent on average every year, that is in a "death spiral", and that is vanishing in large parts of America."

Since then Obamacare insurers packed up and left Iowa.



And western Missouri.



And now maybe Nebraska.



Medica Health, Nebraska’s last remaining Obamacare compliant individual insurance provider, has not yet decided whether it will continue to offer plans next year, according to the Omaha World Herald.

Should Medica join the ranks of providers that have left the state’s Obamacare exchanges, some 100,000 Nebraskans will be left without an option for Obamacare insurance.

At last count, only four of the original 24 Obamacare co-ops remain.

Even if you are one of the lucky ones with a stable Obamacare system, the rate hikes will be pretty steep this year again.



This doesn't mean that Obamacare can't limp along for a many years before simply petering out. In fact that appears to be its destiny.

Unless the GOP repeal it.



Senate Republicans remain publicly pessimistic about their prospects of repealing and replacing Obamacare this year with several raising concerns this week about the party’s central campaign promise even as one of their leaders vowed to pass such a bill this summer.

Sen. Richard Burr (R-N.C.) made the most direct prediction on Thursday, telling a news station in his home state that “I don’t see a comprehensive health care plan this year.”

So the danger of a GOP repeal isn't very high in the short-term, but that doesn't mean there isn't any danger to Obamacare from the GOP, such as longer enforcing the individual mandate.



I've been warning for months now that the Trump administration is doing everything possible to disrupt, undermine and otherwise sabotage the ACA exchanges as much as possible. Yes, the GOP in general has been doing so for 7 years now, but they've really shifted it into overdrive now that they hold all the cards.

Now the good news

There is a possible silver lining in Obamacare's demise - Medicare for all.



In addition to a new poll showing it would be extraordinarily popular, California's single-payer bill—the Healthy California Act—would also cut costs while providing coverage for all.

That is the conclusion of a new analysis (PDF) published on Wednesday by the Political Economy Research Institute (PERI).

"We estimate that, through implementation of Healthy California, overall costs of providing full health care coverage to all Californians could fall by about 18 percent relative to spending levels under the existing system," the authors of the report note.

The California bill passed the Senate and now goes to the Assembly.

New York may be on the verge of passing universal health care as well.

If NY and CA pass Medicare for all, then Obamacare will essentially be replaced in two states where it was most successful.

It would seal the fate of Obamacare, but also pave the road to a better system.

I find it deliciously ironic that it could be progressives, not Republicans, that would deliver the coup de grâce to Obama's Legacy.

Meanwhile, Medicare for all bill has 112 cosponsors in the House.