The most prominent efforts have been in Congress, where the latest move has been to insist on holding the government budget hostage to cut funds intended for ACA implementation.
But the most disruptive activity has been at the state level. Twenty-one states have refused to expand their Medicaid programs, blowing a hole in the ACA's coverage strategy. The Urban Institute estimates 5 million people won't get coverage as a result.
Republicans at the state level also have applied a variety of less visible measures to impede the law's implementation. Some won't enforce consumer protections, including a ban on insurance companies rejecting patients with pre-existing conditions. The result will be illegal discrimination.
Another tactic has been restricting the work of federal "navigators," consumer assistants who help people understand their options and get coverage. The result will be more people without health insurance.
Though some analysts offer explanations for why state governments might make one or another of these decisions, states taking these steps are unwise at best. To the extent they represent a deliberate policy to derail the law, such steps are worse than misguided. .
Congress enacted the Affordable Care Act. The Supreme Court found most of its provisions to be constitutional. Republicans, having opposed the bill and supported the legal challenge to it, are entitled to be unhappy about the outcome, though in our view they are wrong on the merits.
They are not entitled to obstruct and flout the laws of the nation. They have an obligation to cooperate in good faith with wholly legitimate laws duly passed and reviewed by all three branches of government.