Public Opinion and the State Politics of the Affordable Care Act

Since the passage of the Patient Protection and Affordable Care Act, several attempts have been made to block its provisions in the states. Among these, ballot propositions challenging the individual mandate have occurred in five states, with four more scheduled for November 2012. We first provide state-level estimates of public opinion on the ACA since the beginning of 2010, and we show that, consistent with models of partisan resonance, polarization of public opinion is greatest near elections that politicize health care. We then use synthetic control methods to estimate the causal effects of the high-profile public campaigns surrounding these proposition elections, finding these effects to be conditioned by the broader political context of the campaign. In Ohio, where the campaign took place without simultaneous major candidate elections, we find effects on opinion of about seven percentage points. These effects are fairly short-lived, persisting a few months