Enacted in 2010, the Patient Protection and Affordable Care Act (ACA) has reshaped U.S. health policy. Yet overall opinions on the law remained relatively stable during the few years before and after enactment. In a polarized era, can the implementation of a complex program such as the ACA influence public opinion through a policy feedback? Research on policy feedbacks and self-interest provide competing expectations. To address that question, we consider the impact of the Medicaid expansion which took place in select states. Using differences-in-differences estimation and 2010-2017 surveys of more than 51,000 non-elderly American adults, we show that the Medicaid expansion made low-income Americans on average 4.4 percentage points more favorable toward the ACA (SD=1.7) relative to those in non-expansion states. Given that we find no such effect for high-income respondents, these results are consistent with an impact via self-interest and with a policy feedback on public opinion.

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医疗补助扩张和对平价医疗法案的态度：测试对大众意见的政策反馈

2010 年颁布的《患者保护和平价医疗法案》(ACA) 重塑了美国的卫生政策。然而，在颁布前后的几年里，对该法的总体意见保持相对稳定。在两极分化的时代，ACA这样的复杂项目的实施能否通过政策反馈影响舆论？对政策反馈和自身利益的研究提供了相互竞争的期望。为了解决这个问题，我们考虑了在特定州发生的医疗补助扩张的影响。使用差异估计和 2010-2017 年对超过 51,000 名非美国老年人的调查，我们表明，医疗补助计划的扩张使低收入美国人对 ACA 的偏好平均提高了 4.4 个百分点（SD = 1.7）。那些在非扩张状态。