Association for Public Policy Analysis & Management

As E.E. Schattschneider first noted more than 80 years ago, “policies make politics.” In this paper, we ask whether such policy feedback effects help account for the surprising outcome of the 2016 presidential election. In particular, we offer a variety of county- and individual-level analyses to examine whether the troubled implementation of Obamacare led to a political backlash that penalized Hillary Clinton, the Democratic Party’s nominee.

Obamacare provides a particularly useful empirical opportunity to examine how policies ultimately end up shaping politics. Its implementation attracted significant national attention in the midst of the presidential campaign. In late July, it became clear that many insurers would exit the online insurance marketplaces created by the law, leaving nearly a quarter of all counties with no competition in the individual health insurance market. Just two weeks before the election, news that premiums on the exchanges would increase by more than 20 percent on average attracted more negative publicity.

Despite the critical attention surrounding the law, we find no evidence that Obamacare hurt Clinton — and indeed find some evidence that it may have helped. Using marketplace enrollment data and information about the number of plans offered in each county’s exchange, we find evidence that Clinton over-performed in jurisdictions where more people relied on the Obamacare exchanges to purchase their insurance. Perhaps surprisingly, we find evidence that this was driven primarily by consumers who purchased unsubsidized insurance without the benefit of federal tax credits — a group we expect was disproportionately made up of patients with pre-existing conditions. We find similar effects using individual-level public opinion polls, including panel data, that include information about the type of health insurance used by consumers and their political attitudes.

Understanding how voters react to policy implementation is important because their response shapes the incentives of elites — both the incentives to adopt policies designed to address complex social problems in the first place and, for the opposition party, to incentives to undermine the programs’ implementation to reap electoral benefits.