Offsetting Policy Feedback Effects: Evidence from the Affordable Care Act
52 Pages Posted: 22 Apr 2019 Last revised: 9 Jul 2019
Date Written: July 5, 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 those most likely to be uninsured.
Keywords: public opinion, policy feedback effects, Affordable Care Act, health insurance, causal inference
JEL Classification: I13, H4
Suggested Citation: Suggested Citation