Dissecting Perceptions: Exploring the Determinants of Health‐Care Reform Preferences*

Abstract

Objective. There is significant research regarding health-care preferences in other nations and racial preference for health-care providers. However, minimal research examines health-care reform preferences in the United States. Therefore, this study aims to fill this void by demonstrating how a subterranean agenda, or attitudes toward race that manifest themselves into policy, at least partially drove public opinion regarding the Affordable Care Act (ACA). Methods. Drawing from a nationally representative sample in the 2012 Blair Center-Clinton School Poll, this study examines how various "subterranean" elements in addition to economic, demographic, sociological, ideological, regional, and conditional factors shaped attitudes toward the ACA. Results. Testing multiple hypotheses, we found that a subterranean agenda shaped preferences for ACA along with various other factors, such as presidential approval, individuals' perception regarding the role of the federal government, ideology, feeling toward blacks, feeling toward the Tea Party, and a conditional effect between a person's financial status and feeling toward blacks. Conclusion. Preference for ACA is complex and driven by a multitude of factors. Future studies should explore the dynamics of public opinion over time and other state-level and temporally driven factors that may increase or decrease the probability of individuals supporting health-care reform.

Picturing the populations who could benefit from health insurance access expansions: An analysis of US health insurance television ads airing in 2018

“…The politics of health care, however, remain increasingly racialized and thus limit the potential for health outcomes proportionate to the significance of this policy achievement (Michener, 2021). Specifically, large segments of the public remain resistant to ideas of expanding access to health insurance (Kaiser Family Foundation, 2021) and scholars have provided evidence of how Americans' racist attitudes affect public opinion of the need for health care policy reform (Mitchell & Dowe, 2019), perceiving reform as less of a priority when populations of color benefit (Knowles et al, 2010; McCabe, 2019). Republican policymakers at all levels of government have opposed expansions to the Medicaid program (Cassidy, 2017) and many have been part of efforts to propose restrictive and racist policies such as work requirements that limit eligibility, disproportionately burden individuals of color, and play to partisan fallacies about work and health (Alker et al, 2018; Grogan & Park, 2017; Haeder et al, 2021).…”