The Role of Public Opinion—Does It Influence the Diffusion of ACA Decisions?
Journal of Health Politics Policy and Law
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,
... xpectations, 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. Does public opinion in one state influence the policy decisions of other states? While there is general agreement that policy makers consider the opinions of their own residents (Konisky 2007), few scholars offer theoretical advancements for understanding how or when public opinion matters for the spread of ideas. Instead, scholars focus on elite-driven This work has been supported (in part) by award #94-16-05 from the Russell Sage Foundation. Any opinions expressed are those of the author(s) alone and should not be construed as representing the opinions of the foundation.