The Role of Public Opinion-Does It Influence the Diffusion of ACA Decisions?

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, 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.