Beneficiaries of the Affordable Care Act Became More Positive about it Once the Law was Implemented

It has become all too obvious during the COVID-19 pandemic that gaps exist in the largely employer-based U.S. health insurance system.

A new policy brief from the UC Davis Center for Poverty & Inequality Research reveals how utilization of the Affordable Care Act (ACA)—enacted as a means toward filling such gaps—has enhanced public support for the law and may, thereby, secure its future.

The brief, authored by Adrienne Hosek, an assistant professor in the UC Davis Department of Political Science, expands upon Dr. Hosek’s findings published in the Journal of Health Politics, Policy and Law in 2019. Her study focused on early implementation of the ACA and compared responses to surveys (from the ACA series of the American Life Panel) conducted in the month before the start of the first period of open enrollment during winter 2013-14 to those conducted after that open enrollment period ended.

Dr. Hosek’s findings indicate that those who had enrolled in plans offered in the health insurance marketplaces “had significantly more positive opinions of the ACA” after their enrollment than before. But those who lived in any of the 20 U.S. states that had refused federal funds to expand Medicaid coverage in the first year of ACA implementation, and “whose income would have qualified them for Medicaid, but who remained uninsured as a result of their state’s decision,” were significantly less favorable of it.

Dr. Hosek notes that states have tended to reverse their initial refusal of Medicaid expansion funds since the early days of ACA implementation and “as more and more individuals rely on the ACA…” the ACA may become another politically “untouchable” policy, joining Medicare. She believes it is therefore possible that the ACA or some other “form of government-organized and subsidized health insurance market will become a widely accepted method for filling the gaps in the U.S. employer-based insurance system.”