Back in 2006, Democrats ran on reforming the health care system because that was Americans’ top domestic priority. Premiums were skyrocketing and costs were rising at a rapid pace. More than 15% of the country had no insurance and the number was rising. Other people had limits on benefits that left them destitute when they encountered serious illnesses or injuries. Democrats won that year in a landslide, taking control of both the House and Senate.

Two years later, Democratic presidential candidates Barack Obama and Hillary Clinton made health care reform the centerpiece of the nominating process. They had a series of debates that focused, in large part, on their different visions for changing the system to make insurance more affordable, expand access to care, and control costs. Again, Democrats won in a landslide.

Americans were clearly not happy with their health care system, but the Great Recession changed their priorities. Instead of worrying about losing their health care, people were worried about losing their jobs and their houses. Still, Obama went ahead with his pledge to reform the health care system—and paid a steep political price.

Six years later, the Affordable Care Act is still not popular, but there’s no evidence that it’s any less popular than the system we had before. Today, fewer than 9% of the country lacks health coverage and, despite the gnashing of teeth over premium increases, they are still 20% lower than predicted in 2009, the year before the Affordable Care Act was passed.

Most people want Obamacare reformed, not repealed. Republicans in Congress, though, have been promising their base that they would repeal Obamacare as soon as they got power. Now, it’s time for them to put up or shut up and the repeal suddenly doesn’t look so good.

Full repeal will kick millions of people off their insurance and drop more from Medicaid rolls. It will re-open the infamous “doughnut hole,” increasing the cost of prescription drugs for millions of seniors. The deficit will skyrocket, pre-existing conditions will return, and people will suddenly find lifetime limits on their insurance. Republican governors who expanded Medicaid are asking Congress not to repeal that part of it because they’ve seen the benefits.

The GOP could have pledged to fix the system, but instead, they’ve been telling America that Obamacare is a disaster that’s harming our economy and causing premiums to skyrocket. Come hell or high water, they’re going to repeal Obamacare. And the whole country is going to feel the pain.

In North Carolina, repeal will cause more than 500,000 people to lose their coverage. Another 75,000 or so stand to lose their jobs. The state refused to expand Medicaid, leaving an additional 500,000 or so people without coverage.

Last week, Governor Roy Cooper pledged to expand Medicaid and filed the paperwork with the Department of Health and Human Services to get it done. The GOP-controlled legislature says Cooper’s move is illegal since they passed a law in 2013 taking that power away from the governor. The fight will end up in court but even if Cooper loses that battle, he’s set the terms of the debate. Republicans in North Carolina want to deny health coverage to 500,000 citizens while the GOP in Washington is stripping it away from millions more across the country. Chances are, Cooper is on the winning side of that argument.