In the presidential campaign, the rhetoric still can get hot. Texas Senator Ted Cruz says the ACA is “the biggest job-killer in this country. Millions of Americans have lost their jobs.” Over all, from March 2010, when the law was enacted until today, the economy has added 13.7 million jobs.)

But most Republicans insist that they would keep popular provisions such as guaranteeing coverage for people with pre-existing conditions. Governor John Kasich embraced the ACA’s expansion of Medicaid in Ohio. The Republican front-runner, Donald Trump, has said he likes the mandate to get health insurance — the centerpiece of the ACA and chief target of most conservative critics — and that he wouldn’t let people “die sitting in the middle of the street.”

When speculation surfaced of a possible Trump-Kasich pairing, the conservative Weekly Standard lamented that it’d be “The Nightmare Ticket for Opponents of Obamacare.”

If Republicans win in November, however, even Trump would have to try to dismantle the law. The targets: the Medicaid expansion, the mandate (though with some replacement), and cutting subsidies. The problem would be that millions of newly insured would likely lose coverage, creating a political backlash.