Policy Feedback, Partisanship, and the Making of American Citizenship

• In Event: Policy Feedback and Health Inequity in America

Abstract

The Patient Protection and Affordable Care Act (ACA) of 2010 introduced the most comprehensive health reform since the Johnson Administration. Since the passage of the ACA, policy scholars have written much about the implementation of health care reform and the law’s initial feedback effects, finding that the appreciation of ACA’s benefits has translated into increased favorability toward health care reform and more active political participation. Researchers have also tracked the divisiveness over the ACA and frequent political challenges to its continuation. The complexity of health politics surrounding the ACA raises important questions: In the context of divisive partisan politics, can adopted policies reinforce positive attitude toward health care reform and promote civic/political participation? Does partisanship override the appreciation of the ACA’s benefits?

The proposed paper will build on existing policy feedback research and explore how the ACA’s policy design shapes individuals’ attitudes and participation behavior. In particular, we focus on multiple dimensions of policy design that might shape citizen attitudes and political behavior, including the visibility of benefits, the sources of benefits (e.g., public vs. private sources), perceived burden (e.g., taxes), and sociotropism (e.g., if a policy benefits others in the community or the country as whole). We further explore the conditional nature of these policy feedback effects through the lens of partisanship. Specifically, we examine if these institutional sources of feedback effects might be more salient among Republican party loyalties, who are otherwise resistant to the benefits of health care reform. Our empirical analysis draws from an original longitudinal survey that tracks a nationally representative sample of adults. The survey has interviewed the same individuals biannually before each mid-term and presidential election, producing five waves of survey data from 2010 to 2018. Our panel data include measures capturing ACA’s policy designs, individuals’ self-reported experiences with the health care law, their health care opinion and political participation. We use dynamic panel data models and causal mediation analysis to examine how partisanship interplay with policy designs in shaping one’s political behavior.

Authors

• Ling Zhu, University of Houston

• Lawrence R. Jacobs, University of Minnesota, Twin Cities

• Suzanne Mettler, Cornell University