Offsetting Policy Feedback Effects: Evidence from the Affordable Care Act

73 Pages Posted: 22 Apr 2019 Last revised: 6 May 2020

See all articles by William R. Hobbs

William R. Hobbs

Cornell University

Daniel J. Hopkins

University of Pennsylvania

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

Hobbs, William R. and Hopkins, Daniel J., Offsetting Policy Feedback Effects: Evidence from the Affordable Care Act (March 13, 2020). 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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