Attitudinal Policy Feedback and the Affordable Care Act

Awarded Scholars:
Julianna Pacheco, University of Iowa
Project Date:
Jul 2016
Award Amount:
Project Programs:
Co-funded Research
The Social, Economic and Political Effects of the Affordable Care Act

Findings: Attitudinal Policy Feedback and the Affordable Care Act; Julianna Pacheco, University of Iowa

Co-funded with the Robert Wood Johnson Foundation

While several elements of the Affordable Care Act (ACA) have received strong public support, a 2015 Pew Research Center poll finds that 49% of Americans still disapprove of the law. Why have so many Americans not supported the ACA? One view hypothesizes that individuals base their opinions on collective evaluations of how health reform influences the country instead of personal evaluations of how the law influences their families. Another view cites the highly partisan nature of healthcare reform, where partisanship is more likely to influence opinion than personal benefits. Finally, individuals may not yet have cognitively linked the ACA to their personal situation, either because not enough time has passed for them to understand how it affects their families or because many are uninformed about how policies impact their daily lives.

Political scientist Julianna Pacheco argues that by ignoring state level variation, scholars have missed an opportunity to better understand the effects of the ACA on opinion. She will examine variations in state policies and state implementation to explore how these differences influence mass attitudes—a process called attitudinal policy feedback. There are two pathways through which the ACA can influence opinion: either directly through implementation, where policies have the potential to change opinions through individual experiences, or indirectly through the information environment. Pacheco will use small area estimation techniques to measure state trends in support for the ACA, perceptions of the law’s effect on one’s family, the country, and the uninsured, and support for analogous policies in the future. She will also measure trends in state opinion across subsets of residents based on self-interest, partisanship, and political knowledge to sort out whether reactions to policies are shaped by personal gain, long-standing partisan attachment, or knowledge. Finally, she will evaluate how state-level preferences react to ACA decisions in other states.


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