Offsetting Policy Feedback Effects: Evidence from the Affordable Care Act

Abstract

The US welfare state provides key benefits indirectly. The Affordable Care Act (ACA), for example, uses a package including exchanges, subsidies, and penalties to increase health insurance enrollment. Prior research indicates that indirect policies do not produce feedback effects on public opinion, but the ACA was unusually salient and complex. Can such indirect policies produce feedback effects, and are any such effects heterogeneous? Here, we use several data sets and inferential strategies to show that groups especially affected by the exchanges and the associated insurance mandate did shift their ACA attitudes, albeit in opposing directions and with more limited effects than descriptive analyses suggest. Those who experienced rising local prices became more opposed to the ACA, while those who stood to benefit from some changes to the individual markets became more favorable. Overall, positive changes in attitudes were offset by demographically concentrated, negative shifts among the uninsured.