Federalism and Public Opinion on Healthcare: The Design of the Affordable Care Act's Insurance Exchanges and User Experience with the Exchanges.

Using original survey data and the 2016 American National Election Study (ANES), we examine the effects of healthcare exchange type and user experience on individuals' support for the Affordable Care Act (ACA). States are divided into three different types of ACA exchange implementation regimes: sta...

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Bibliographic Details
Published in:Publius: The Journal of Federalism Vol. 50; no. 1; pp. 55 - 81
Main Authors: Liebertz, Scott, Bunch, Jaclyn, Shaw, Thomas
Format: Article
Published: Oxford University Press / USA Winter2020
Subjects:
Online Access:View this record in EBSCOhost
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      dt: Winter2020
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        atl: Federalism and Public Opinion on Healthcare: The Design of the Affordable Care Act's Insurance Exchanges and User Experience with the Exchanges.
      aug:
        au:
          Liebertz, Scott
          Bunch, Jaclyn
          Shaw, Thomas
        affil: University of South Alabama
      su:
        United States
        Public opinion
        Health policy
        Citizen satisfaction
        Federal government of the United States
        Patient Protection & Affordable Care Act
        Health policy laws
      sug:
        subj:
          Public opinion
          Health policy
          Citizen satisfaction
          United States
          Administration of Public Health Programs
          Federal government of the United States
          Patient Protection & Affordable Care Act
          Health policy laws
      ab: Using original survey data and the 2016 American National Election Study (ANES), we examine the effects of healthcare exchange type and user experience on individuals' support for the Affordable Care Act (ACA). States are divided into three different types of ACA exchange implementation regimes: state-run exchanges, federally operated exchanges, and mixed state-federal exchanges. We hypothesize that individuals in states running their own exchanges will demonstrate greater support for the ACA and individuals with experience using the exchanges will exhibit greater levels of support for the ACA. Results from a survey conducted in 2016 in Alabama (a federal exchange), Kentucky (a state exchange at the time), and Arkansas (a mixed state-federal exchange) support these hypotheses. These findings are also confirmed using national data from the ANES. We therefore provide evidence that local control over healthcare implementation leads to better outcomes in terms of citizen satisfaction and that citizens who have experience with exchanges established by the ACA are more likely to feel positively about the law.
      pubtype: Academic Journal
      doctype: Article
      src: R
    language: English
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