Structural Framing: Health Care Reform and Changing American Politics

Abstract

Research on public opinion toward public policy, including health policy, tends to focus on short-term dynamics and to emphasize the impact of discrete messages communicated by individual speakers in particular situations. This focus on what we term “situational framing,” while valuable in some respects, has limitations: it fails to assess changes that may occur over the longer term; it neglects to consider how policies themselves, in the course of implementation, shape outcomes; and it is poorly equipped to assess the actual extent of change, which may be variable and conditional. We introduce the concept of “structural framing,” how institutionalized policies may convey (or fail to convey) routinized messages to recipients and perhaps mass public generally over long periods of time, by chronically accessing their stored attitudes and beliefs. We have commenced a long-term project that will use the analytic leverage of both situational framing and structural framing to examine the public’s overall reactions to the Affordable Care and Patient Protection Act of 2010 as well as its perceptions of the law’s key components. In this paper, we develop the concept of “structural framing,” drawing on the literature to consider its applicability to health care policy. We also both analytical approaches to examine the first wave of data in a long-term panel study we are conducting. We find that while early attitudes toward ACA are highly influenced by partisanship and socio-economic characteristics, which is illustrative of situational framing, such patterns are mitigated by policy effects in the lives of individuals who have experienced a discernable impact in their own lives, providing evidence of structural framing.

Keywords: Health care, public policy, public opinion