The role of group-based attitudes in policy evaluation: the relationship between sexism, racism, and attitudes toward the affordable care act

In this paper, we examine White Americans’ negative attitudes toward government involvement in healthcare, i.e. the Affordable Care Act (ACA). Past research has documented that opinions toward the ACA can be explained, at least in part, by racial attitudes. We show that sexism is also consistently and significantly associated with attitudes toward the ACA. Using five representative surveys fielded between 2016 and 2024, as well as a survey experiment, we find that racism and sexism are both associated with opposition to the ACA and that these relationships persist over time even when we account for alternative theories. For example, our randomized survey experiment shows that respondents’ attitudes cannot be explained by the connection of healthcare reform with individual political figures (e.g. Barack Obama or Hillary Clinton). We argue that opposition to the ACA, in part, represents the growing trend in American politics where social identities and attitudes toward groups become salient dimensions of policy evaluation, and we suggest that these policy attitudes may reflect a desire to maintain existing social hierarchies.