We show that personal experiences with the Affordable Care Act informed voting behavior and that these effects could have altered the election outcome in pivotal states, suggesting that Republican efforts to undermine the law’s implementation paid tangible political dividends.

This is from the abstract in “Did Obamacare Implementation Cost Clinton the 2016 Election?” by Vladimir Kogan and Thomas J. Wood.

I hadn’t been aware that Republicans had tried to undermine the law’s implementation. So I read the paper to see what Kogan and Wood had in mind. In reading the paper, I found that they went even further with their language. Note this statement:

Nevertheless, exchange enrollees appear to have held the Democratic Party primarily responsible, suggesting that intentional efforts by Republicans to sabotage the implementation of the health care law paid tangible political dividends among this constituency (but not, apparently, among the broader electorate).

Sabotage? Wow. That’s pretty strong language.

Finally I got to the evidence of their undermining and sabotage:

In addition, although the health care law was identified most prominently with the Obama administration, Republican leaders made a number of critical decisions that affected enrollment trends and contributed to the rising premiums. In a number of states, for example, Republican officials used state consumer protection laws to impose onerous licensing and certification requirements on “navigators”–enrollment counselors funded by the Affordable Care Act to help individuals apply for insurance. Many states also refused to move policies previously purchased on the individual market–overwhelmingly by healthier consumers–to the exchanges to improve the overall risk pool and reduce average premiums for the plans sold there. Most Republican-controlled states also opted out of the Medicaid expansion, after a Supreme Court ruling made participation voluntary. In addition, the Obama administration put forward a variety of proposals designed to stabilize the exchanges and reduce premiums of plans sold there–including further standardization of plan offerings, getting express congressional approval for cost-sharing reductions designed to reduce out-of-pocket costs for lower-income enrollees, and increasing federal funding for “risk corridors” designed to protect insurers against higher-than-expected actuarial losses that received little support (or even consideration) from the Republican congressional majority.

So let’s consider these claims one by one.

Republican officials used state consumer protection laws to impose onerous licensing and certification requirements on “navigators–enrollment counselors funded by the Affordable Care Act to help individuals apply for insurance.

That is sabotage. Shame on those Republicans. Score one for Kogan and Wood. And Kogan and Wood’s emotive language suggests that they think there was something wrong with that. Good for them. I hope to see them come out against other onerous licensing and certification requirements in other occupations. It’s a target-rich environment.

Many states also refused to move policies previously purchased on the individual market–overwhelmingly by healthier consumers–to the exchanges to improve the overall risk pool and reduce average premiums for the plans sold there.

This is hard to categorize because the authors don’t tell us enough. Was there a legal requirement that these state governments move those policies to the exchanges? (Doing so by the way, would hurt those healthier consumers.) If so, then that policy was sabotage. If not, then it wasn’t.

Most Republican-controlled states also opted out of the Medicaid expansion, after a Supreme Court ruling made participation voluntary.

This was clearly not sabotage. The authors themselves admit that participation was voluntary. Taking advantage of a policy that’s voluntary is not sabotaging that policy.

In addition, the Obama administration put forward a variety of proposals designed to stabilize the exchanges and reduce premiums of plans sold there–including further standardization of plan offerings, getting express congressional approval for cost-sharing reductions designed to reduce out-of-pocket costs for lower-income enrollees, and increasing federal funding for “risk corridors” designed to protect insurers against higher-than-expected actuarial losses that received little support (or even consideration) from the Republican congressional majority.

In other words, Obama wanted to supplement Obamacare with more subsidies and Republicans refused. Refusing to support supplementation of a law is not sabotage of that law.

HT2 Tyler Cowen.