Association for Public Policy Analysis & Management

The mass public’s beliefs about who benefits from a given social policy are politically consequential. An extensive literature links the mass public’s perceptions of the beneficiaries of programs like Social Security, Medicare, and welfare, to benefit take-up (Newman 1999; Soss 1999), and to the administration and entrenchment/retrenchment of those programs over time (Campbell 2003; Oberlander 2003; Patashnik and Zelizer 2013; Soss, Fording and Schram 2011). These patterns in turn shape a policy’s capacity to reduce political and economic inequality. Yet, the mass public’s beliefs about a policy’s beneficiaries do not simply mirror the facts of who actually benefits from a policy; rather beliefs are also influenced by framing effects, media portrayals, and motivated reasoning (Chong 1996; Iyengar 1990; McCabe 2016; Nelson and Kinder 1996).

This paper uses original data, gathered by the author through the 2016 Cooperative Congressional Election Study (CCES), to report on two descriptive questions: (1) Whom does the mass public believe are the recipients of two of the 2010 Patient Protection and Affordable Care Act’s (ACA’s) most well-known and tangible benefits—expanded Medicaid, and tax credits that go to people 100-400% FPL purchasing insurance on HealthCare.gov or state insurance marketplaces? (2) What share of the mass public believes that ACA beneficiaries actually need these benefits; and, what share thinks that these beneficiaries are taking advantage of the system—in other words, are undeserving (e.g. Katz 2013)? Answers are compared to those that respondents provide regarding the beneficiaries of Medicare—a longstanding, highly popular public health insurance program. Answers are also compared to administrative data on the actual distribution of ACA benefits. After presenting these results, the paper studies how answers to these two descriptive questions vary by respondent partisanship, respondent income level, and the ACA implementation decisions made by the respondent’s state of residence. By reporting on public perceptions of ACA beneficiaries during the 2016 election, this paper helps to delineate a key piece of the political context that surrounded proposals to revise and repeal parts of the ACA as a new presidential administration and new congressional majority—both opposed to the ACA—ascended to power in 2017.