The ACA is the law of the land, in spite of a prolonged campaign of sabotage

The Supreme Court’s ruling last year gave states the right to opt out of the Medicaid expansion, which is one of the most significant pieces of the ACA in terms of the impact it will have on the uninsured and its importance to the overall success of the law. More than twenty states—most fully controlled by Republicans in the legislature and the governor’s office—are denying some of the neediest Americans care by refusing to expand the program. Some 9.7 million of the 15 million potentially eligible adults live in states that are refusing to expand or have not indicated whether they will do so.

Refuse to create state insurance exchanges

More than half the states have declined to establish their own insurance marketplaces. All but six are run by Republican governors and a Republican-majority legislature. Residents will still be able to buy insurance through the federal exchange, but without cooperation and promotion from state officials, it will be more difficult to reach the uninsured.

Waste time and money voting for repeal

In the past three years, House Republicans have devoted at least 15 percent of their time on the House floor trying to ruin the ACA, voting thirty-nine times to repeal, defund or delay the law. These legislative efforts have cost taxpayers upward of $50 million. Meanwhile, the GOP hasn’t offered any alternative healthcare plans of its own. These votes present no existential threat to the law, since repeal will never get through the Senate or the White House. But repeated attacks reinforce the idea that the ACA is still up for debate and that its future is uncertain. As of April, four in ten Americans were unaware that the ACA is the law and that it is being implemented.

Block improvements to the law

While implementation has brought certain weaknesses in the ACA to light, there’s about zero chance that the GOP will support operational or funding fixes. Some of the concerns raised—for example, that employers will cut full-time workers in order to avoid providing insurance for their employees—could be met with simple changes. If the GOP’s full-out attack on the Obama administration after its decision to delay the employer mandate for a year in order to smooth out some of these issues is any indication, the GOP will do no more than exploit efforts to improve the law.

Publicize misinformation

Republicans squawking about rate shocks are presenting misleading numbers, particularly in Indiana and Ohio. One of the simplest ways the GOP fudges calculations to make anticipated premium prices look higher than they will be is by not factoring in the federal subsidies that will cut the cost of the premiums for most people buying coverage. Expect the volume of lying to rise when legislators return to their home districts during the August recess.

Discourage private partnerships

When Massachusetts was promoting Romneycare in 2007, the state partnered with the Red Sox to educate residents about the new law and encourage enrollment. Public education is key to the ACA rollout, too, and the White House has enlisted celebrities and sports franchises to raise awareness, particularly in target groups like healthy young men. The GOP is trying to scare off potential partners, and it has already succeeded with the NFL.

Refuse to assist constituents

Not only are Republicans spreading misinformation and ruining education campaigns, they have also indicated that they won’t help confused constituents navigate the law or access benefits. Congressional offices expect a wave of calls once enrollment begins in the fall, but several Republicans told The Hill they weren’t preparing to answer questions. “All we can do is pass them back to the Obama administration,” Utah Representative Jason Chaffetz said. “They’re responsible for it.”