Publication Date

April 2017


Erika Franklin Fowler




English (United States)


Public attitudes about the Patient Protection and Affordable Care Act (ACA) have been polarized since the law’s passage. The law directly affected few individuals, and therefore, most learned about the implementation and its effects in health care through the lens of the mass media. While past research suggests that media can be influential in shaping opinion, it is generally thought to be less influential under polarization. However, during the first open enrollment period, locally broadcast ACA-related media messages (in the form of news media stories and health insurance advertisements) flourished as sponsors, insurance marketers, supporters, and opponents sought to shape the public perceptions of the law. By merging data on volumes of messaging at the media market level with nationally representative survey data, I examine the relationship between estimated exposure to media messaging and the public’s perceptions of how informed they were about and favorable toward the ACA during January and March 2014. By capitalizing on the resurgence of health care reform on the political agenda in 2017, an original survey is fielded to determine how messaging has causally shaped public attitudes about favorability toward the American Health Care Act (AHCA) and preference between the ACA and the AHCA. By understanding how opinions are formed with respect to the AHCA, the experiment provides insight into how media messaging may have influenced attitudes during the first open enrollment period. I find that increased exposure to message content in both insurance advertising and local news coverage in January 2014 are associated with participants’ subjective knowledge of the law during that time. Media messaging content, both in 2014 and today, are also associated with participant’s favorability toward the law, but the relationship appears to be conditioned by political party identification, supporting the partisan perceptual bias theory.



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