Obamacare Implementation and the 2016 Election

Abstract

We combine administrative records from the federal health insurance exchange with aggregate- and individual-level voting data to examine how health care reform affected the 2016 election. Overall, we find that personal experiences with the Affordable Care Act influenced voting decisions and conceivably altered the presidential election outcome in pivotal states, suggesting that Republican efforts to undermine the law's implementation paid tangible political dividends. We also show that voters purchasing coverage through the exchange responded to premium price hikes publicized shortly before the election -- despite most receiving a tax credit that largely shielded them from the increases. We hypothesize that the exchange website's design and information in renewal letters sent by insurers reduced the salience of federal subsidies and made consumers needlessly sensitive to the "sticker prices" of health insurance. Survey responses collected before the premiums became public provide additional evidence that the premium effects are indeed causal.

Keywords: 2016 Presidential Election, Obamacare, Affordable Care Act, Policy Feedback, Retrospective Voting, Health Policy

JEL Classification: I13, I18, H50, H51, H70, H77