The Feedback Effects of Market-Based Policy: Evidence from ACA Opinions

• In Event: Formation of Mass Attitudes

Abstract

How does public policy influence public opinion? Can politicized and market-based policies generate uni-directional policy feedbacks? The Affordable Care Act (ACA) is complex and multi-faceted, relying partly on insurance exchanges and other market-based mechanisms to increase health insurance enrollment. Yet prior research has focused on its Medicaid expansion. Here, we employ various data sets---including a geo-coded rolling cross-section (n=117,000) and a novel, population-based panel---to assess the impact of the ACA's exchanges. Descriptive analyses demonstrate those who use the exchanges are more supportive of the ACA, but they represent only 2% of respondents, and are disproportionately Democratic. Subsequent analyses using a variety of inferential designs and administrative data on exchange pricing indicate that although the exchanges might shift attitudes under limited circumstances, their causal impact was small. The largest changes in attitudes did not correspond to the introduction of insurance exchanges. By providing insurance through a complex array of levers targeting different populations, and by foregrounding market-based mechanisms, the ACA's architects may have muted its feedback effects.

Authors

• William Hobbs, Cornell University

• Daniel J. Hopkins, University of Pennsylvania