Offsetting Policy Feedback Effects: Evidence from the Affordable Care Act
73 Pages Posted: 22 Apr 2019 Last revised: 6 May 2020
Date Written: March 13, 2020
The U.S. welfare state provides key benefits indirectly. The Affordable Care Act (ACA), for example, uses a package including exchanges, subsidies, and penalties to increase health insurance enrollment. Prior research indicates that indirect policies do not produce feedback effects on public opinion, but the ACA was unusually salient and complex. Can such indirect policies produce feedback effects, and are any such effects heterogeneous? Here, we use several data sets and inferential strategies to show that groups especially affected by the exchanges and the associated insurance mandate did shift their ACA attitudes, albeit in opposing directions and with more limited effects than descriptive analyses suggest. Among our findings, those who experienced rising local prices became more opposed to the ACA while those most likely to benefit from the individual markets' price caps became more favorable. Overall, positive changes in attitudes were offset by demographically concentrated, negative shifts among the uninsured.
Keywords: public opinion, policy feedback effects, Affordable Care Act, health insurance, causal inference
JEL Classification: I13, H4
Suggested Citation: Suggested Citation