Offsetting Policy Feedback Effects: Evidence from the Affordable Care Act
56 Pages Posted: 22 Apr 2019
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: Suggested Citation