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The GOP has done more than 'not vote for it.' Much more. There was the court challenge that resulted in making medicare expansion a state option, followed by the refusal of many states to expand it, leaving many low-income people with no affordable coverage option. Then there is the refusal of many states to set up state exchanges. One-state-at-a-time seems to have been a much more doable IT task, the state exchanges are working well where they exist. I don't think it's too much to say the Republicans have been trying everything they can in many states to actively sabotage the ACA.
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