Chances are good that your health insurance is bad — and getting worse.

If you have ObamaCare, the deductibles and co-pays keep going up, the networks keep getting narrower, and every year you have to go through an incredibly complicated and stressful enrollment process.

If you have employer-based insurance, likely the exact same things are happening, if at a somewhat slower pace.

And if you're uninsured — well, you don't need me to tell you about that.

Who's fault is this sorry state of affairs? There's plenty of blame to go around, but Republicans are right at the top of the list.

The Trump administration has been deliberately sabotaging the ObamaCare exchanges. Most recently, it announced that it would again slash funding to "navigators," the nonprofits that help people navigate the complicated enrollment process. For 2017 the funding was $62.5 million; now it's down to $10 million. Worse, the navigators will now be directed to recommend that people enroll in crummy, cheap plans — potentially causing an insurance death spiral as the healthy population is creamed off into garbage plans, leaving only sick people in the other insurance pools.

That comes on top of the GOP's evisceration of ObamaCare advertising and outreach and the deletion of "cost-sharing reduction" payments. Ironically, this latter move may have accidentally helped people on the exchanges slightly (due to the policy's janky design), but all these moves have been unquestionably aimed at worsening the quality of coverage on the ObamaCare exchanges.

Now, it is true that ObamaCare was a cramped vision of health policy that is way too complicated and has some rather staggering design errors. Nevertheless, its exchanges and Medicaid expansion have provided coverage to millions of people, and its regulatory structures have helped tens of millions more with employer-based coverage. At every point where Trump's appointees could have chosen to operate the federal bureaucracy to make coverage cheaper and better, they have chosen the opposite.

More fundamentally, Republicans have had the run of all three branches of government for the last year and a half — a rare situation in our antiquated constitutional system. In a democracy, the government is supposed to address the needs of its citizens. There are lots of health-care models that might provide universal coverage — and in a dark sort of advantage, the American health-care system is so terrible that practically every other country that isn't an outright failed state is doing better than us, giving us plenty of models to choose from. All we would need is to copy-paste from somewhere with a demonstrated functioning model — from the public-private mix in Switzerland to Medicare-for-all systems in many countries to the National Health Service in Britain. Heck, you could just draw a country out of a hat, and go with that — it might not be the best option overall, but it's certain to be better than our festering, gangrenous system.

Republicans promised over and over and over again that their alternative to ObamaCare would offer coverage that is both cheaper and better. Paul Ryan said their policy would protect people with pre-existing conditions. Kellyanne Conway promised that Medicaid would be protected, while then-Secretary of Health and Human Services Tom Price swore up and down that nobody would be kicked off that program.

In reality, as even a cursory glance at the health-care bill the GOP repeatedly failed to pass last year reveals, Republicans' actual policy preference is to slash social insurance programs (particularly Medicaid) and other health-care subsidies and regulations, causing tremendous suffering and probably hundreds of thousands of deaths annually, so they can cut taxes on rich people. It was only the defection of three Republican senators — swayed by a deluge of constituent calls, many begging not to be killed — that prevented that goal from being achieved.

So if your coverage is bad — if you're paying through the nose for premiums, or your deductible and co-pays are going through the roof, or you're constantly fighting with the insurance company over payments, or getting your treatments denied, or facing 10-fold increases in drug prices, or being balance-billed for more than your annual income — it's Republicans' fault. They run the government, and could have fixed the system. Instead they have chosen consistently and repeatedly to make it worse wherever they can.