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AJM online Letter| Volume 129, ISSUE 5, e27, May 01, 2016

Why Do So Many White Americans Oppose the Affordable Care Act?

DOI:https://doi.org/10.1016/j.amjmed.2015.08.041
Why Do So Many White Americans Oppose the Affordable Care Act?
Previous ArticleA Common But Not so Typical Elevated Anion Gap
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      Dalen et al
      • Dalen J.E.
      • Waterbrook K.
      • Alpert J.S.
      Why do so many Americans oppose the Affordable Care Act?.
      Am J Med. 2015; 128: 807-810
      offer plausible explanations for opposition to the Affordable Care Act (ACA). Yet, although 50% of whites report unfavorable views, only 20% of blacks and 27% of Latinos do so.

      The Henry Kasier Family Foundation. Kaiser health tracking poll: the public's views on the ACA. Available at: http://kff.org/interactive/tracking-opinions-aca/#?response=Favorable-Unfavorable&aRange=twoYear&group=Race%2520%252F%2520Ethnicity::White::Black::Hispanic. Accessed August 20, 2015.

      These national polling data suggest a narrower, but unsettling question: why do so many white Americans oppose the ACA?
      One explanation for this divide in opposition is that relatively more minority Americans are uninsured and might benefit; more blacks and Latinos than whites report being helped than hurt by the ACA.

      Newport F. Americans slightly more positive toward Affordable Care Act. Available at: www.gallup.com/poll/182318/americans-slightly-positive-toward-affordable-care-act.aspx. Accessed August 20, 2015.

      Those opposing ACA cite both ideology (concerns with government involvement in healthcare and the insurance mandate) and self-interest (ACA costs, and impact on their own health care).

      Pew Research Center. Chapter 2: views of the Affordable Care Act and its future. Available at: www.people-press.org/2014/05/05/views-of-the-affordable-care-act-and-its-future/. Accessed August 20, 2015.

      The racial divide in opposition goes beyond self-interest. The election of the first black president polarized public attitudes by race, with racialization spilling over into healthcare attitudes.
      • Tesler M.
      The spillover of racialization into health care: how President Obama polarized public opinion by racial attitudes and race.
      Am J Pol Sci. 2012; 56: 690-704
      How the ACA is labeled affects respondents' attitudes.

      Hart Research/Public Opinion Strategies. All American Economic Third Quarter Survey. September, 2013. Available at: http://fm.cnbc.com/applications/cnbc.com/resources/editorialfiles/2013/09/26/FI10863c-release%209-25-13.pdf. Accessed November 12, 2015.

      Specifically, unfavorable views increased when it was referred to as “Obamacare” rather than the Affordable Care Act.
      Racial attitudes affect views on national policy. Public support for redistribution programs declines when recipients are portrayed as black.

      Soroka SN, Harell A, Iyengar S. Racial cues, prejudice and attitudes toward redistribution: a comparative experimental approach. Paper presented at the American Political Science Association annual meeting, 2013, Chicago, Ill. Available at: http://economie.esg.uqam.ca/upload/Harell__12-2014.pdf. Accessed August 20, 2015.

      Experimental elicitation of anger triggers greater opposition to the ACA among those reporting unfavorable views of blacks.
      • Banks A.J.
      The public's anger: white racial attitudes and opinions toward health care reform.
      Polit Behav. 2014; 36: 493-514
      Opposition to Medicaid expansion, perhaps the most contentious ACA provision, is highest in conservative states where expressed racial resentment is greatest.

      Lanford D, Quadagno J. Implementing ObamaCare: the politics of Medicaid expansion under the Affordable Care Act of 2010. Sociol Perspect. 2015:0731121415587605.

      Henderson et al
      • Henderson M.
      • Hillygus D.S.
      The dynamics of health care opinion, 2008-2010: partisanship, self-interest, and racial resentment.
      J Health Polit Policy Law. 2011; 36: 945-960
      examined factors that predicted a shift to healthcare reform opposition between 2008 and 2010. They found little change among African Americans. Factors that predicted a shift from support to opposition included conservative political affiliation, self-interest, and greater racial resentment.
      In summary, opposition to ACA is largely by white Americans. This opposition seems to be associated with increasing political polarization surrounding the Obama presidency, perceived self-interest, and racial attitudes.

      References

        • Dalen J.E.
        • Waterbrook K.
        • Alpert J.S.
        Why do so many Americans oppose the Affordable Care Act?.
        Am J Med. 2015; 128: 807-810
        View in Article

      2. The Henry Kasier Family Foundation. Kaiser health tracking poll: the public's views on the ACA. Available at: http://kff.org/interactive/tracking-opinions-aca/#?response=Favorable-Unfavorable&aRange=twoYear&group=Race%2520%252F%2520Ethnicity::White::Black::Hispanic. Accessed August 20, 2015.

        View in Article

      3. Newport F. Americans slightly more positive toward Affordable Care Act. Available at: www.gallup.com/poll/182318/americans-slightly-positive-toward-affordable-care-act.aspx. Accessed August 20, 2015.

        View in Article

      4. Pew Research Center. Chapter 2: views of the Affordable Care Act and its future. Available at: www.people-press.org/2014/05/05/views-of-the-affordable-care-act-and-its-future/. Accessed August 20, 2015.

        View in Article
        • Tesler M.
        The spillover of racialization into health care: how President Obama polarized public opinion by racial attitudes and race.
        Am J Pol Sci. 2012; 56: 690-704
        View in Article

      6. Hart Research/Public Opinion Strategies. All American Economic Third Quarter Survey. September, 2013. Available at: http://fm.cnbc.com/applications/cnbc.com/resources/editorialfiles/2013/09/26/FI10863c-release%209-25-13.pdf. Accessed November 12, 2015.

        View in Article

      7. Soroka SN, Harell A, Iyengar S. Racial cues, prejudice and attitudes toward redistribution: a comparative experimental approach. Paper presented at the American Political Science Association annual meeting, 2013, Chicago, Ill. Available at: http://economie.esg.uqam.ca/upload/Harell__12-2014.pdf. Accessed August 20, 2015.

        View in Article
        • Banks A.J.
        The public's anger: white racial attitudes and opinions toward health care reform.
        Polit Behav. 2014; 36: 493-514
        View in Article

      9. Lanford D, Quadagno J. Implementing ObamaCare: the politics of Medicaid expansion under the Affordable Care Act of 2010. Sociol Perspect. 2015:0731121415587605.

        View in Article
        • Henderson M.
        • Hillygus D.S.
        The dynamics of health care opinion, 2008-2010: partisanship, self-interest, and racial resentment.
        J Health Polit Policy Law. 2011; 36: 945-960
        View in Article

      Article Info

      Footnotes

      Funding: None.

      Conflict of Interest: None.

      Authorship: The author had access to the data and played a role in writing this manuscript.

      Identification

      DOI: https://doi.org/10.1016/j.amjmed.2015.08.041

      Copyright

      © 2015 Elsevier Inc. All rights reserved.

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      Linked Article

      • Why do so Many Americans Oppose the Affordable Care Act?
        The American Journal of MedicineVol. 128Issue 8
        • Preview
          The Patient Protection and Affordable Care Act (ACA) was passed by a Democratic Congress and signed into law by a Democratic president in 2010. Republican congressmen, governors, and Republican candidates have consistently opposed the ACA and have vowed to repeal it. Polls have consistently shown that it is supported by <50% of Americans. The most important goal of the ACA is to improve the health of Americans by increasing the number covered by health insurance. In the first year of its implementation, more than 10 million citizens gained health insurance.
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      • The Reply
        The American Journal of MedicineVol. 129Issue 5
        • Preview
          I thank Fiscella for his comments on the article on the Affordable Care Act.1 I agree that it is very likely that blacks and Latinos are more likely to have favorable views toward the Affordable Care Act than whites because they are more likely to be uninsured.
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