Public Opinion on the Affordable Care Act

August 14, 2017

In May 2017, Republican leaders in the U.S. House of Representatives presented the American Health Care Act (AHCA), a bill designed to repeal and replace Obama’s 2010 Affordable Care Act (ACA). The GOP bill was eventually defeated in the Senate, and when Republicans attempted to pass a newer version in July, the Senate again struck it down.

As the New York Times has reported, public opinion on the ACA has shifted since the 2016 presidential election, especially following the GOP’s introduction of their bill, which the CBO has estimated would leave an additional 22 million citizens uninsured. According to the Times, more Americans now support the ACA than oppose it, and “voters have besieged their representatives with emotional telephone calls and rallies, urging them not to repeal.”

As part of the Russell Sage Foundation’s special initiative on the social, political, and economic effects of the Affordable Care Act, RSF grantee Daniel Hopkins (University of Pennsylvania) has studied how public attitudes toward the ACA have formed and changed over time. In a paper recently published by Political Behavior, Hopkins explores the influence of elite rhetoric on citizens’ opinions of the ACA. He finds that while the highly charged Congressional debates of 2009-2010 had limited effect overall on American’s attitudes toward health care reform, there is evidence that this rhetoric did influence the language citizens used to discuss the ACA in surveys conducted by Kaiser and Pew Research. For example, survey respondents who opposed the ACA were were more likely to adopt the same words and framing used by Republican policymakers following a public statement or press release by the GOP, including words like “pay” and “cost” to discuss possible negative impacts of the ACA. Similarly, respondents in favor of the reform used language similar to Democratic elites’ (including “affordable” and “provide”) after exposure to public statements from Democratic leadership. “In short,” Hopkins writes, “elite rhetoric appears more likely to change the rationale underpinning evaluations of the ACA than to change the evaluations themselves.”

Hopkins has also recently released a working paper, co-authored with Kalind Parish (University of Pennsylvania), that examines people’s attitudes toward the ACA after its adoption in 2010. In particular, the authors analyze the impact of the ACA’s Medicaid expansion in select states and find that these expansions made low-income Americans more supportive of the ACA. Given that drastically reducing Medicaid coverage has been a cornerstone of the GOP’s American Health Care Act, this research—as well as Hopkins’ earlier work on the limited influence of elite rhetoric in shifting public opinion—suggest that the bill, which has been highly contested and deeply unpopular, may not find additional public support in the coming months.

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