Skip to main content Accessibility help
×
Home

Policy Uptake as Political Behavior: Evidence from the Affordable Care Act

  • AMY E. LERMAN (a1), MEREDITH L. SADIN (a1) and SAMUEL TRACHTMAN (a1)

Abstract

Partisanship is a primary predictor of attitudes toward public policy. However, we do not yet know whether party similarly plays a role in shaping public policy behavior, such as whether to apply for government benefits or take advantage of public services. While existing research has identified numerous factors that increase policy uptake, the role of politics has been almost entirely overlooked. In this paper, we examine the case of the Affordable Care Act to assess whether policy uptake is not only about information and incentives; but also about politics. Using longitudinal data, we find that Republicans have been less likely than Democrats to enroll in an insurance plan through state or federal exchanges, all else equal. Employing a large-scale field experiment, we then show that de-emphasizing the role of government (and highlighting the market's role) can close this partisan gap.

Copyright

Corresponding author

Amy E. Lerman, University of California, Berkeley, 2607 Hearst Ave, Berkeley, CA 94720 (alerman@berkeley.edu).
Meredith L. Sadin, University of California, Berkeley, 2607 Hearst Ave, Berkeley, CA 94720 (msadin@berkeley.edu).
Samuel Trachtman, University of California, Berkeley, 210 Barrows Hall, Berkeley, CA 94720 (sam.trachtman@berkeley.edu).

Footnotes

Hide All

The authors gratefully acknowledge the financial support of the Russell Sage Foundation; the Robert Wood Johnson Foundation Scholars in Health Policy Research Program; Professor Jack Citrin and the Institute of Governmental Studies at UC Berkeley; and the National Science Foundation. We are also indebted to Enroll America and the Kaiser Family Foundation for partnering with us in this research. Thanks also to Ed Coleman, John Ellwood, Ann Keller, Gabe Lenz, Neil O'Brian, and Robert Van Houweling, as well as the anonymous reviewers and editors of the APSR, for their helpful comments on early drafts of this work.

Footnotes

References

Hide All
Aber, Lawrence J., Bennett, Neil G., Conley, Dalton C., and Li, Jiali. 1997. “The Effects of Poverty on Child Health and Development.” Annual Review of Public Health 18: 463–83.
Aizer, Anna, and Currie, Janet. 2004. “Networks or Neighborhoods? Correlations in the Use of Publicly-funded Maternity Care in California.” Journal of Public Economics 88 (December): 2573–85.
Allison, Paul. 2012. “How Relevant is the Independence of Irrelevant Alternatives?” Statistical Horizons, October 8, 2012. Retrieved May 15, 2017 (https://statisticalhorizons.com/iia)
Alonso-Zaldivar, Ricardo. 2014. “Probe exposes flaws behind Healthcare.gov rollout.” AP News, July 31. Retrieved June 13, 2016 (http://apnews.excite.com/article/20140731/us-health-overhaul-de4c72c273.html).
Barsky, Robert B., Juster, F. Thomas, Kimball, Miles S., and Shapiro, Matthew D.. 1997. “Preference Parameters and Behavioral Heterogeneity: An Experimental Approach in the Health and Retirement Study.” The Quarterly Journal of Economics 112 (2): 537–79.
Ben-Shalom, Yonatan, Moffitt, Robert, and Schloz, John Karl. 2012. “An Assessment of the Effectiveness of Anti-Poverty Programs in the United States.” In Oxford Handbook of Economics of Poverty, ed. Jefferson, Phillip N.. New York, NY: Oxford University Press, 709–49.
Bertrand, Marianne, Mullainathan, Sendhil, and Shafir, Eldar. 2006. “Behavioral Economics and Marketing in Aid of Decision Making among the Poor.” Journal of Public Policy and Marketing 25 (1): 823.
Bhargava, Saurabh, and Manoli, Dayanand. 2015. “Psychological Frictions and the Incomplete Take-Up of Social Benefits: Evidence from an IRS Field Experiment.” American Economic Review 105 (November): 3489–529.
Blank, Rebecca, and Ruggles, Patricia. 1996. “When Do Women Use AFDC & Food Stamps? The Dynamics of Eligibility vs. Participation,” Journal of Human Resources 31 (1): 5789.
Blavin, Fredric, Shartzer, Adele, Long, Sharon K., and Holahan, John. 2016. “Employer-Sponsored Insurance Stays Strong, with No Signs of Decay under the ACA: Findings through March 2016. Urban Institute Health Policy Center, July 13. Retrieved May 20, 2017 (http://hrms.urban.org/briefs/employer-sponsored-insurance-aca-march-2016.html).
Campbell, Angus, Converse, Philip E., Miller, Warren E., and Stokes, E. Donald. 1960. The American Voter. New York, NY: John Wiley and Sons.
Chetty, Raj, Looney, Adam, and Kroft, Kory. 2009. “Salience and Taxation: Theory and Evidence.” American Economic Review 99:4 (September): 1145–77.
Chetty, Raj, and Saez, Emmanuel. 2013. “Teaching the Tax Code: Earnings Responses to an Experiment with EITC Recipients.” American Economic Journal: Applied Economics 5:1 (January): 131.
Chong, Dennis. 2006. “Free Speech and Multiculturalism In and Out of the Academy.” Political Psychology 27:1 (February): 2954.
Chong, Dennis, and Druckman, James N.. 2007. “Framing Theory.” Annual Review of Political Science 10: 103–26.
Converse, Phillip E. 1964. “The Nature of Belief Systems in Mass Publics.” In Ideology and Discontent, ed. Apter, David E.. New York: The Free Press of Glencoe, 206–61.
Currie, Janet. 2000. “Do Children of Immigrants Make Differential Use of Public Health Insurance?” In Issues in the Economics of Immigration, ed. Borjas, George. Chicago, IL: University of Chicago Press.
Currie, Janet M. 2006. “The Take-up of Social Benefits.” In Poverty, the Distribution of Income, and Public Policy, eds. Auerbach, Alan, Card, David, and Quigley, John. New York, NY: Russell Sage, 80148.
Currie, Janet, and Grogger, Jeffrey. 2002. “Medicaid Expansions and Welfare Contractions: Offsetting Effects on Maternal Behavior and Infant Health.” Journal of Health Economics 21:2 (March): 313–35.
Daponte, Beth, Sanders, Seth, and Taylor, Lowell. 1999. “Why Do Low-Income Households Not Use Food Stamps? Evidence from an Experiment.” Journal of Human Resources 34:3 (Summer): 612–28.
Ericson, Keith Marzilli, and Starc, Amanda. 2012. “Heuristics and Heterogeneity in Health Insurance Exchanges: Evidence from the Massachusetts Connector.” American Economic Review 102:3 (May): 493–97.
Fiorina, Morris P., and Abrams, Samuel J.. 2008. “Partisan Polarization in the American Public.” Annual Review of Political Science. 11 (1): 563–88.
Flores, Bill, Roe, Phil, and Scott, Austin. 2015. “A Conservative Alternative to Obamacare.” National Review, March 4. Retrieved June 22, 2016 (http://www.nationalreview.com/article/414808/conservative-alternative-obamacare-bill-flores-phil-roe-austin-scott).
Gamson, William A., and Modigliani, Andrew. 1987. “The Changing Culture of Affirmative Action.” In Research in Political Sociology, ed. Braungart, Richard D.. Greenwich, CT: Jai Press, 137–77.
Gilens, Martin. 2000. Why Americans Hate Welfare: Race, Media, and the Politics of Antipoverty Policy. Chicago, IL: University of Chicago Press.
Green, Donald, Palmquist, Bradley, and Schickler, Eric. 2004. Partisan Hearts and Minds: Political Parties and the Social Identities of Voters. New Haven, CT: Yale University Press.
Haselswerdt, Jake, and Bartels, Brandon L.. (2015) “Public Opinion, Policy Tools, and the Status Quo Evidence from a Survey Experiment.” Political Research Quarterly 68 (3): 607–21.
Hoynes, Hilary, Schanzenbach, Diane Whitmore, and Almond, Douglas. 2016. “Long Run Impacts of Childhood Access to the Safety Net.” American Economic Review 106 (April): 903934.
Jennings, M. Kent, and Stoker, Laura. 2005. “Political Similarity and Influence Between Husbands and Wives.” In The Social Logic of Politics: Personal Networks as Contexts for Political Behavior, ed. Zuckerman, Alan S.. Philadelphia, PA: Temple University Press. 5174.
The Kaiser Family Foundation. 2010–2016. Kaiser Health Tracking Poll. http://www.kff.org/tag/tracking-poll/
Kinder, Donald R., and Sanders, Lynn M.. 1990. “Mimicking Political Debate with Survey Questions: The Case of White Opinion on Affirmative Action for Blacks.” Social Cognition 8 (1): 73103.
Kinder, Donald R., and Sanders, Lynn M.. 1996. Divided by Color: Racial Politics and Democratic Ideals. Chicago, IL: Chicago University Press.
Lawrence, Regina G. 2004. “Framing Obesity: The Evolution of News Discourse on a Public Health Issue.” The International Journal of Press/Politics 9 (3): 5675.
Lee, David. 2009. “Training, Wages, and Sample Selection: Estimating Sharp Bounds on Treatment Effects.” The Review of Economic Studies 76 (3): 10711102.
Leip, Dave. 2017. “David Leip's Atlas of U.S. Presidential Elections, Datasets.”, doi:10.7910/DVN/XX3YJ4, Harvard Dataverse, V2
Lenz, Gabriel. 2012. Follow the Leader? How Voters Respond to Politicians' Policies and Performance. Chicago, IL: University of Chicago Press.
Levitt, Larry, Damico, Anthony, Cox, Cynthia, and Claxton, Gary. “Mapping Marketplace Enrollment.” Kaiser Family Foundation. Retrieved February 13, 2017 (http://kff.org/interactive/mapping-marketplace-enrollment/)
Madrian, Brigitte C., and Shea, Dennis F.. 2001. “The Power of Suggestion: Inertia in 401(k) Participation and Savings Behavior.” Quarterly Journal of Economics 116 (4): 1149–87.
Maloy, Simon. 2015. “This is What Ripping Holes in Obamacare Looks Like: The Horrific Human Cost of the GOPs Anti-reform Crusade.” Salon, May 13. Retrieved June 13, 2016 (http://www.salon.com/2015/05/13/this_is_what_ripping_holes_in_obamacare_looks_like_the_horrific_human_cost_of_the_gops_anti_reform_crusade/).
Marken, Stephanie. July 11 2016. “U.S. Uninsured Rate Remains at Historical Low of 11.0%.” Princeton NJ: Gallup. Retrieved January 26, 2017. (http://www.gallup.com/poll/193556/uninsured-rate-remains-historical-low.aspx).
Mettler, Suzanne. 2007. Soldiers to Citizens: The G.I. Bill and the Making of the Greatest Generation. New York, NY: Oxford University Press.
Mettler, Suzanne. 2011. The Submerged State: How Invisible Government Policies Undermine American Democracy. Chicago, IL: University of Chicago Press.
Moffitt, Robert A. 1983. “An Economic Model of Welfare Stigma.” American Economic Review 73 (December): 1023–35.
Moffitt, Robert. 2003. “The Role of Nonfinancial Factors in Exit and Entry in the TANF Program.” The Journal of Human Resources 38: 1221–54.
Morin, Rick, Taylor, Paul, and Patten, Eileen. 2012. “A Bipartisan Nation of Beneficiaries.” Washington, DC: Pew Research Center. Retrieved June 13, 2016 (http://www.pewsocialtrends.org/2012/12/18/a-bipartisan-nation-of-beneficiaries/).
Mullainathan, Sendhil, and Shafir, Eldar. 2013. Scarcity: The New Science of Having Less and How It Defines Our Lives. New York, NY: Picador.
Nelson, Thomas E., Clawson, Rosalee A., and Oxley, Zoe M.. 1997. “Media Framing of a Civil Liberties Conflict and Its Effect on Tolerance.” American Political Science Review 91 (3): 567–83.
Nelson, Thomas E., and Kinder, Donald R.. 1996. “Issue Frames and Group-centrism in American Public Opinion.” Journal of Politics 58 (4): 1055–78.
Newport, Frank. September 17, 2012. “Majority in U.S. Still Say Government Doing Too Much.” Princeton NJ: Gallup. Retrieved June 2016. (http://www.gallup.com/poll/157481/majority-say-government-doing.aspx )
Niemi, Richard G., and Jennings, M. Kent. 1991. “Issues and Inheritance in the Formation of Party Identification.” American Journal of Political Science 35:4 (November): 970988.
Nisbet, Matthew C., Brossard, Dominique, and Kroepsch, Adrianne. 2003. “Framing Science: The Stem Cell Controversy in an Age of Press/Politics.” The International Journal of Press/Politics 8 (2): 3670.
O'Donoghue, Ted, and Rabin, Matthew. 1999. “Doing It Now or Later.” American Economic Review 89 (March): 103–24.
Office of Inspector General, Health and Human Services. 2014. “An Overview of 60 Contracts That Contributed to the Development and Operation of the Federal Marketplace.” Washington, DC: Department of Health and Human Services. Retrieved June 13, 2016 (http://oig.hhs.gov/oei/reports/oei-03-14-00231.asp).
Pew Research Center. 2010. “The People and Their Government: Distrust, Discontent, Anger and Partisan Rancor.” Washington, DC: Pew Research Center. Retrieved June 13, 2016 (http://www.people-press.org/files/legacy-pdf/606.pdf).
Pew Research Center. 2012. “Obama Health Care Law: Where Does the Public Stand.” Washington DC: Pew Research Center. Retrieved January 25, 2017. (http://www.people-press.org/2012/06/15/obama-health-care-law-where-does-the-public-stand/)
Pew Research Center. 2015. “Beyond Distrust: How Americans View Their Government: Broad Criticism, but Positive Performance Ratings in Many Areas.” Washington DC: Pew Research Center. Retrieved May 1, 2017. (http://www.people-press.org/files/2015/11/11-23-2015-Governance-release.pdf).
Rasinski, Kenneth A. 1989. “The Effect of Question Wording on Public Support for Government Spending.” Public Opinion Quarterly 53 (3): 388–94.
Shah, Dhavan V., Watts, Mark D., Domke, David, and Fan, David P.. 2002. “News Framing and Cueing of Issue Regimes: Explaining Clinton's Public Approval in Spite of Scandal.” Public Opinion Quarterly 66 (3): 339370.
Smeeding, Timothy M., Phillips, Katherin Ross, and O'Connor, Michael. 2000. “The EITC: Expectation, Knowledge, Use, and Economic and Social Mobility.” National Tax Journal 53 (4): 1187–209.
Sniderman, Paul M., and Theriault, Sean M.. 2004. “The Structure of Political Argument and the Logic of Issue Framing.” In Studies in Public Opinion: Attitudes, Nonattitudes, Measurement Error, and Change, eds. Sarris, Willem E. and Sniderman, Paul M.. Princeton: Princeton University Press, 133–65.
Tesler, Michael. 2012. “The Spillover of Racialization into Health Care: How President Obama Polarized Public Opinion by Racial Attitudes and Race.” American Journal of Political Science 56 (3): 690704.
Tesler, Michael. 2015. “More Democrats are Getting Health Insurance, Thanks to Obamacare. Why are Republicans Staying Away?” The Washington Post, July 16. Retrieved June 13, 2016 (https://www.washingtonpost.com/blogs/monkey-cage/wp/2015/07/16/more-democrats-are-getting-health-insurance-thanks-to-obamacare-why-are-republicans-staying-away/).
Weatherford, M. Stephen. 1982. “Interpersonal Networks and Political Behavior.” American Journal of Political Science 26 (1): 117–43.
White, Halbert. 1980. “A Heteroskedasticity-Consistent Covariance Matrix Estimator and a Direct Test for Heteroskedasticity.” Econometrica: Journal of the Econometric Society 48 (4): 817838.
The White House. 2015. “Long Term Benefits of the Supplemental Nutrition Assistance Program.” Washington, DC: The White House. Retrieved June 13, 2016 (http://www.hwcli.com/wp-content/uploads/2015/12/SNAP_report_final_.pdf).
U.S. Department of Health and Human Services. 2007. “Report to Congress.” Washington, DC: Health and Human Services. Retrieved June 13, 2016 (http://aspe.hhs.gov/hsp/indicators07/report.pdf).
U.S. Department of Health and Human Services. 2016. “Health Insurance Coverage and the Affordable Care Act, 2010–2016.” Washington, DC: Health and Human Services. Retrieved June 18, 2017. (https://aspe.hhs.gov/pdf-report/health-insurance-coverage-and-affordable-care-act-2010-2016)
“US Economy: The Tea Party is a Real Threat to America.” 2011. The Guardian, July 31. Retrieved June 13, 2016. (http://www.theguardian.com/commentisfree/2011/jul/31/observer-editorial-us-economy).
Zaller, John. 1992. The Nature and Origins of Mass Opinion. Cambridge, UK: Cambridge University Press.
Type Description Title
UNKNOWN
Supplementary materials

Lerman et al. Dataset
Dataset

 Unknown
PDF
Supplementary materials

Lerman supplementary material
Online Appendix

 PDF (1.7 MB)
1.7 MB

Policy Uptake as Political Behavior: Evidence from the Affordable Care Act

  • AMY E. LERMAN (a1), MEREDITH L. SADIN (a1) and SAMUEL TRACHTMAN (a1)

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed