All three cited sources are reachable and their quotes are accurate. (1) Senate Roll Call Vote #200 confirms the question text verbatim ("On Cloture on the Motion to Proceed... to S. 4653") and Ernst's Yea vote; the bill protected the ACA and blocked DOJ from helping strike it down; result 51-43, failed to reach 60. (2) The Tillis PROTECT Act release lists Joni Ernst as a co-sponsor and contains the exact pre-existing-conditions guarantee/anti-discrimination language quoted. (3) PBS NewsHour's six-Republican sentence including "Iowa Sen. Joni Ernst" matches exactly. The promise is compound and internally contradictory (repeal-and-replace the ACA while protecting pre-existing conditions). The repeal-and-replace half never occurred and was not driven by Ernst; the pre-existing-conditions half she genuinely advanced via cosponsorship and a floor vote — both of which in fact cut against repeal. PARTIAL fairly reflects one half delivered and one half neither achieved nor pursued, and does not overstate the evidence. Two minor supporting details in the original rationale (the "in the court's hands / not an attorney" quote and the Oct 2019 short-term-plans vote) are uncited, but they are secondary and do not affect the three verified pillars.