In the nearly seven years since the passage of the Affordable Care Act the Republican Party has made it clear that, given the opportunity, they would repeal it regardless of the cost.

At the time I assumed that by the end of President Obama’s 2nd term it would be so entrenched that even the Republicans wouldn’t try to repeal it.

There is a precedent here. On August 14, 1935 President Franklin Roosevelt signed into law the Social Security Act. I’m guessing everyone knows this, but during our working years we contribute part of our earnings into a fund that will provide us a retirement when we are too old to work.

Predictably, Republicans at the time opposed it and when President Roosevelt ran for re-election 1936 his opponent, Kansas Governor Alf Landon promised to repeal it. Governor Landon lost, and no serious presidential candidate has opposed it since (I’m aware that several current Republicans refer to Social Security as a ponzi scheme but nobody takes them seriously).

Simply put, the Republican Party provides us a history of not caring about poor people and those they don’t like. Under conditions of the ACA, the states had the opportunity to “buy in” to an expansion of Medicaid (also called MediCal in California) and have the federal government pay to nearly all of it. Many of us honestly believed that Republican states were more greedy than hateful and would accept the money the federal government offered them to implement it.

We were wrong. Their visceral hate of President Obama mattered more to them than the health of their poorest constituents. As of now 32 states (and the District of Columbia) accept the Medical option and 19 don’t. You can see the map here.

And now we have a President Elect who promises to “repeal and replace.” But it’s more complicated. On the day after his election Trump met with President Obama and came out of the meeting promising to keep two provisions. He promised to keep the provision that allowed children to stay on their parents’ policy until age 26 and he promised to keep the provision that prevented insurance companies from denying coverage for pre-existing conditions.

But here’s the problem: those who don’t like the ACA especially don’t like the individual mandate but insurance companies depend on it. They reasonably argue that if customers could purchase insurance after a serious diagnosis that nobody would buy health insurance before they needed it. It’s the equivalent of waiting until your house is on fire before buying fire insurance.

Insurance companies depend on a large pool of people who pay premiums for coverage they don’t need and the only way they can’t exclude sick people is by collecting the premiums of well people.

The Republican Congress (and in a few days the White House) pledge to repeal and replace but have no plan. They oppose the ACA but propose nothing. I’ve spoken about this here but many of us fear they will repeal and abandon the 20 million people who have health care because of President Obama.