Offsetting Policy Feedback Effects: Evidence from the Affordable Care Act

56 Pages Posted: 22 Apr 2019

See all articles by William R. Hobbs

William R. Hobbs

Cornell University

Daniel J. Hopkins

University of Pennsylvania

Date Written: April 4, 2019


Can politicized, market-based policies generate policy feedbacks? The Affordable Care Act (ACA) is complex, relying partly on new exchanges, subsidies, and penalties to increase health insurance enrollment. Yet prior research focuses on changes to Medicaid, a pre-existing program. We employ several data sets -- including a rolling cross-section (n=117,000) and a novel, population-based panel -- to assess the exchanges' impacts on public opinion. Descriptive analyses demonstrate that exchange users are more supportive of the ACA, but they represent 2% of Americans. Subsequent analyses using various inferential strategies indicate that although local price increases on the exchanges reduce support, the exchanges' overall causal effects were limited. We uncover offsetting positive and negative opinion changes among different groups. In contrast with prior hypotheses, our evidence shows that the limited feedback effects overall come from heterogeneity, not invisibility: exchange users connect certain experiences with ACA opinions, but not in ways that consistently bolster their assessments.

Keywords: public opinion, policy feedback effects, Affordable Care Act, health insurance, causal inference

JEL Classification: I13, H4

Suggested Citation

Hobbs, William R. and Hopkins, Daniel J., Offsetting Policy Feedback Effects: Evidence from the Affordable Care Act (April 4, 2019). Available at SSRN: or

William R. Hobbs

Cornell University

Ithaca, NY 14853
United States

Daniel J. Hopkins (Contact Author)

University of Pennsylvania ( email )

Stiteler Hall
Philadelphia, PA 19104
United States


Register to save articles to
your library


Paper statistics

Abstract Views
PlumX Metrics

Under construction: SSRN citations will be offline until July when we will launch a brand new and improved citations service, check here for more details.

For more information