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Republicans really hate Obamacare.

They’ve voted to repeal it, defund it, or change it 67 times in Congress. They’ve raised Supreme Court challenges and blocked efforts on the state level to expand its reach.

All this is well-known to even the most casual political observer. Less appreciated, however, is the human cost of GOP obstructionism. A five-year effort to kill Obamacare is literally killing Americans.

Consider, for example, what happened last week in Tennessee and Wyoming. In both states, Republican governors tried to push plans through their GOP-dominated state legislatures to expand Medicaid, a key part of the Affordable Care Act. Under the law, the federal government initially pays for the entire expansion of the program for poor Americans before phasing its share down to 90 percent by 2020. In Tennessee, the state’s hospital association had agreed to pay any costs beyond those covered by the federal government.

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That wasn’t good enough for Republican state legislators. In Tennessee, that means 280,000 residents will not be eligible for coverage under Medicaid. In Wyoming, 17,000 residents will go uncovered.

The impact will be more severe than simply not being able to see a doctor. According to a 2012 study by Wyoming’s Department of Health, Medicaid expansion could prevent 111 deaths each year. These numbers are based on work done by the Harvard School of Public Health, which found a notable drop in mortality rates in states that expanded their Medicaid programs. The Wyoming study projected that expanding Medicaid would bring an additional $864 million in federal money into the state’s coffers between now and 2020 and put a dent in the nearly $200 million Wyoming hospitals spend each year for uncompensated care.

But neither financial nor moral arguments swayed Republican officeholders.

What happened in Wyoming and Tennessee mimics what’s been happening across red state America. Twenty-two states have refused to go along with the Medicaid expansion; all of those states have Republican governors.

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Meanwhile, in Washington the Supreme Court next month will consider a challenge to the ACA from conservative activists based on an evidence-free argument that the law’s architects didn’t intend for the government to provide subsidies to people who bought coverage on federal health insurance exchanges. That’s an argument that runs afoul of the obvious purpose and spirit of the law. If successful, this dubious legal challenge to Obamacare could cost eight million Americans access to health insurance. As for fixing the law to save so many Americans from misfortune, The Wall Street Journal reports that “congressional Republicans say there is no possibility they would allow that.”

If anything, Republicans seem almost gleeful about the Supreme Court possibly hurting so many people. They most likely would say their glee is because Obamacare is so horrible that getting rid of it would do far more good than harm.

The problem is, we know that’s not true. By the end of open enrollment this weekend, sign-ups for an Obamacare health care plan will likely top 10 million people. Millions more are receiving coverage through expanded Medicaid or have been able to stay on their parents’ health plans. Fewer Americans are having problems paying their medical bills; fewer are deferring care because they can’t afford to see a doctor; and fewer are going bankrupt because they’ve gotten sick. Yet these successes haven’t shaken the Republicans’ determination to kill the law.

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Even if GOP efforts to destroy Obamacare reflect a strongly held ideological position — for example, that greater suffering is a necessary price for greater freedom — they should be forced to own that position. Republican state legislators in Wyoming and Tennessee, by their own accounts, put their notions of fiscal rectitude over saving lives and relieving suffering. If congressional Republicans refuse to fix the ACA in the event that it’s devastated by the Supreme Court, they will be doing the same thing.

All too often GOP opposition to Obamacare is described as a political dispute. It’s much more than that, however. Repealing Obamacare, removing federal subsidies for millions of people, and denying Medicaid expansion are all affirmative political acts that will hurt, and even kill, Americans. The Republican position might reflect the party’s strongly held views, but that doesn’t make it any less monstrous.

Related:

Scot Lehigh: What if the GOP gets its ACA wish?

Stephen Soumerai and Ross Koppel: Address economic flaws in Obamacare

Jeff Jacoby: Mass. shows where Obamacare is headed

Michael Cohen: For new Congress, it’s same old, same old


Michael A. Cohen is a fellow at the Century Foundation. Follow him on Twitter @speechboy71.