The Affordable Care Act, Political Partisanship, and Public Opinion

July 18, 2019

The Russell Sage Foundation’s special initiative on the Social, Economic, and Political Effects of the Affordable Act was developed with the support from the Robert Wood Johnson Foundation. Almost ten years since the Affordable Care Act (ACA) was enacted, grants made through this special initiative continue to produce research findings. Here we highlight work by RSF grantees on participation in the ACA along partisan lines and public opinion on the Act. 

Approximately 20 million Americans gained health insurance as a direct result of the enactment of the Affordable Care Act (ACA). Michael Sances (University of Memphis) and Joshua D. Clinton (Vanderbilt University) address the question of whether Democrats, Republicans, or independents were more or less likely to gain health insurance because of the new law in their paper published in the Journal of Health Politics, Policy and Law, “Who Participated in the ACA? Gains in Insurance Coverage by Political Partisanship.” Their data shows that independent voters had the largest increase in insurance coverage (10%), followed by Democrats and Republicans (roughly 8% each). While Democrats appear more likely than Republicans to register for private marketplace plans, both groups of voters were equally as likely to sign up for Medicaid in those states where it was expanded. 

The Affordable Care Act ushered in a watershed moment in terms of expanding health care coverage for Americans, but public opinion about the program remained essentially the same despite increasing exposure to and participation in the program. In 2013, 42 percent of Americans held unfavorable views of the ACA; 44 percent held unfavorable views of the ACA three years later in 2016. Daniel Hopkins (University of Pennsylvania) and Kalind Parish (University of Pennsylvania) examine this question of public opinion on the ACA in their paperThe Medicaid Expansion and Attitudes Toward the Affordable Care Act: Testing for a Policy Feedback on Mass Opinion, published in Public Opinion Quarterly’s Spring 2019 issue. The report concludes that the Medicaid expansion undertaken by some states in the wake of the ACA have led more low-income Americans, who are more likely to be Medicaid-eligible, to look favorably upon the ACA. Non-white and Democrat respondents tended to have more positive opinions of the policy. The authors attribute these differences in public opinion to the fact that Medicaid expansion provided direct assistance to millions, therefore reshaping public opinion. The following chart illustrates the correlation between income levels, receipt of Medicaid, and opinions on the ACA in both expansion and non-expansion states. 

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