Offsetting Policy Feedback Effects: Evidence from the Affordable Care Act

58 Pages Posted: 22 Apr 2019 Last revised: 14 Oct 2019

See all articles by William R. Hobbs

William R. Hobbs

Cornell University

Daniel J. Hopkins

University of Pennsylvania

Date Written: October 11, 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-sectional survey (n=117,000) and a novel, population-based panel--to assess the impacts of the exchanges and individual mandate on public opinion. Descriptive analyses demonstrate that exchange users are more supportive of the ACA. However, subsequent analyses using various inferential strategies indicate that the exchanges' overall causal effects were limited. These limited feedback effects are due to heterogeneity, not invisibility: exchange users connected positive experiences with ACA opinions, but these were offset by price spikes and concentrated, negative attitude changes among the uninsured.

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 (October 11, 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


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