Iowa had to do something. By 2018, every health-care insurer in the state was planning to leave. The Affordable Care Act was collapsing. So now Iowa has proposed changes to "Obamacare" as a fix. One insurer is already on board. As a Republican-run state, Iowa will be watched.

But there’s something deeper than red and blue at work. Along the coasts and in urban areas, Obamacare is lauded. And in those areas, it is showing signs of financial stability. But in rural areas like Iowa, it is failing.

The tendency is to see Obamacare solely through a partisan lens. But as with so much, that can obscure. What Obamacare shows is that rural and urban America – different since the days of the American Revolution – are becoming dramatically more so. The question is whether politics cements those differences into tribal divides or opens itself to solutions flexible enough to encompass all.