The Role of Public Opinion—Does It Influence the Diffusion of ACA Decisions?

Abstract

We consider two ways that public opinion influenced the diffusion of ACA policy choices from 2010 through 2014. First, we consider the policy feedback mechanism, which suggests that policy decisions have spillover effects that influence opinions in other states; residents in the home state then influence the decisions of elected officials. We find that both gubernatorial ACA announcements and grant activity increased support for the ACA in nearby states. Consistent with our expectations, however, only gubernatorial announcements respond to shifts in ACA support, presumably because it is a more salient policy than grant activity. Second, we test for the opinion learning mechanism, which suggests that shifts in public opinion in other states provide a signal to elected officials about the viability of decisions in their own state. We find evidence that states are more likely to emulate other states with similar ACA policy preferences when deciding about when to announce their decisions. Our results suggest that scholars and policy makers should consider how shifts in public support influence the spread of ideas across the American states.

Policy Diffusion in Polarized Times: The Case of the Affordable Care Act

“…Such trade-offs in observability may apply not only to political elites but to the public as a whole. Pacheco and Maltby (2017) demonstrate how citizens in neighboring states take note of other governments' experiments and begin to demand change at home. They establish that the resulting shifts in public opinion in turn influence policy choices.…”

“…Given the polarized political climate, not every governor leapt to embrace the ACA, accept grant funding, and develop a state health exchange. Rather, some governors only came to that position following other states' actions and the public opinion shifts that arose in their own states as a result, as Pacheco and Maltby (2017) establish.…”

The Social, Political, and Economic Effects of the Affordable Care Act: Introduction to the Issue

“…Last is the question of whether elite action, as opposed to rhetoric, can influence public opinion. One study of policy diffusion found that pro-ACA gubernatorial an- nouncements in one state increased public support for the ACA in nearby states, a pattern the authors term "policy spillover" (Pacheco and Maltby 2017).…”

Fertility treatment for the transgender community: a public opinion study

“…Public opinion, meanwhile, can profoundly impact medical policy [23,24] and insurance benefits [25], and in the reproductive medicine field, where insurance coverage remains a controversial issue, public support may promote consequential change. Moreover, public opinion affects media coverage, which in turn influences what the public (including the transgender community) may see as viable options for their care.…”