It is difficult to discern what exactly is the intent of Congressional Republicans when approaching health care legislation. For seven years, the GOP campaigned against the Affordable Care Act. The rhetoric portrayed the bill as a gross overreach of government comparable to Stalin’s five-year plans. Republicans highlighted a delusion that the ACA eradicated the free market of health insurance, triggering an unstoppable rise in premiums. More importantly, they claimed to stand alongside the common American who still struggles to afford health insurance. Republicans promised a system that would work and provide health care to even more Americans than the ACA covered.

Of course, this would only be so if voters in 2016 pledged allegiance to the flawed economic philosophy revered by GOP lawmakers and propelled the party into power at all levels of government. Republicans saw their wish granted as they took a powerful majority in Congress and President Trump entered the White House. An added bonus appeared as most statehouses across the country flew the red flag of GOP conservatism.

So the stage was set for Senate Majority Leader McConnell and Speaker Ryan to triumph over the supposedly poisonous ACA. Republicans would repeal the bill and replace it with a framework that respect markets while empowering Americans of every walk of life.

Now it seems clearer and clearer everyday, beginning with the embarrassing attempt earlier in 2017, that Republicans scammed Americans. In exchange for political power, the poor and middle-class Americans are getting screwed. It is important to be blunt about the group individuals elected to represent Americans who believe they are immune to the repercussions of terrible governing.

It is one thing to be ignorant and inept. It is another to be fully aware, lie, and legislate incompetently. To begin, the Better Care Reconciliation Act or the American Health Care Act, or whichever Orwellian name McConnell wishes to pin on the piece of paper, is not a health care bill. Congressional Republicans made a strategic decision to package their repeal-replace effort as a reconciliation bill. The goal behind this strategy is to avoid a Democrat-led filibuster in the Senate.

By definition, a reconciliation bill is a legislative tool intended to allow passage of a BUDGET bill not subject to filibuster and limited to twenty hours of debate. This reconciliation rule allows for adjustments relating to tax, spending, or the debt limit. By the technics of their strategy, Congressional Republicans are not allowed to overhaul the ACA as a whole and replace it with a revolutionary conservative framework that would alter the way health covered and improved in the United States. Thankfully, they want a tax cut for the wealthy. As the repeal of the Cadillac tax would drive the divide: a family making $200,000 would gain $5,420 on average by 2026 whereas a family making less than $10,000 would lose $2,550.

I do not agree with Senator Rand Paul very often, but when he asserted earlier this year that the effort by House Republicans to replace the ACA was “Obamacare lite” he was quite right. Interestingly, the newest Senate version of the AHCA maintains the 3.8 percent investment tax on incomes over $200,000 and it creates a $70 billion fund designed to help struggling insurers offset their costs. This is similar to the risk-corridor program under the ACA which Senator Marco Rubio and under Republicans stopped as an assault on free-market principles. Is this what Republican voters wanted from the brash and economically sensible candidate? I sincerely doubt it. Especially not now when popularity for the ACA continues to rise.

Here is the fact of the matter: the party that claims to value market-based approaches to legislation is too ignorant or self-interested to understand how health insurance markets work. This is evident in much of their language ranging from the $772 billion cuts in Medicaid and weakening cost-sharing reduction subsidies. But the piece of the legislation that exhibits their idiocy the most is the new Cruz Amendment, or the deceiving Consumer Freedom Amendment.

This feature allows insurers to provide skimpier and cheaper plans that do not adhere to essential health benefits and other ACA requirements as long as that insurer also offers a marketplace plan that adheres to all the ACA regulations. This market segmentation will lead to higher premiums and more costs to every party including government. Why?

In health insurance markets, healthy people tend to wait until they get sick to purchase insurance. This catalyzes a dynamic where insurers cover more and more sick people. To the insurer, this is a costly risk. As a result, they increase premiums thereby pricing sick people out of the market and deterring healthy people from joining the pool. This is called a death spiral spurred by adverse selection. Adverse selection is a market failure which requires government action to ease. That is what President Obama aimed to do with the ACA.

By requiring insurers to sell everyone, regardless of medical history, the same plan at the same price and mandating that everyone, sick or healthy, sign up for insurance, adverse selection would hopefully be managed. Subsidies via an expansion of Medicaid would help those who could still not afford health insurance.

The Cruz Amendment incentivizes healthier people to exit the marketplace to purchase a skimpier and cheaper plan, which will drive up premiums for ACA-approved plans. With this dynamic, the death spiral and adverse selection are inevitable. Markets will fail, you will not have health insurance, and it’s on the GOP.

The ACA had flaws and wasn’t perfect, but Republicans come nowhere near an improvement. In the long run, the most effective piece of legislation that eliminates adverse selection is single-payer. In the short run, the most effective strategy is to improve the ACA via a public option, a risk-corridor program, and raising the cap on CSR subsidy eligibility. This will create a stable market for insurers and, more importantly, Americans.