Investigating women's greater support of the Affordable Care Act

Abstract

Healthcare reform has recently dominated the political agenda. There is a consistent gender gap in healthcare policy preferences, and women are more likely to support the Affordable Care Act than men. This study investigates two explanations for the origins of this gap, which connect to a larger debate in political behavior whether symbolic versus self-interest reasons drive public opinion. The humanitarian hypothesis tests whether gender differences on pro-social values, such as humanitarianism, account for the gender gap in healthcare attitudes. Second, the economic security hypothesis tests whether these gender differences emerge because of women's self-interest due to their higher levels of economic vulnerability. There is support for both hypotheses, and each partially mediates the gap. Together they fully mediate the gender gap.

Keywords:

• Gender gap
• Affordable Care Act
• Gender and political behavior
• Gender and public opinion

Notes

1 The origins of these differences are beyond the scope of this paper; three prominent theories exist including gender roles (Eagly and Steffen, 1984), personality differences (Costa et al., 2001), or feminist consciousness (Conover, 1988).

2 It is also possible there is greater use of the healthcare system by women than by men. Unfortunately, this data cannot be tested as part of the Economic Security Hypothesis.

3 Age bias is of particular concern with internet samples; the mean does not give an accurate indication of whether the sample is skewed toward younger individuals. This is not of concern in this sample, because 85.03% of the respondents are under the age of 65 while 14.97% are 65 and older. This is quite similar to the NES 2008, which has 83.01% of the sample under 65 while 16.99% are 65 and older.

4 Inclusion of interactions between gender and humanitarianism or gender and income would test moderation not mediation. The moderation analysis was performed but neither interaction is significant.

5 Feldman and Steenbergen (2001) provide an in-depth discussion and analysis of the endogeneity of humanitarian values and social welfare attitudes.

6 When employment status is included, it is not significantly related to attitudes toward the Affordable Care Act and did not mediate the gender gap.

7 Again, it is also possible that women's attitudes differ on healthcare because of more frequent doctor visits or because of caretaker roles going to the doctor more often with children and elderly family members. There are no measures to test these possible explanations in the data. Elder and Greene (2008) do not find parenthood to be predictive of healthcare attitudes but find that actively involved parents are more likely to support nationalized healthcare.

8 The final item makes reference to Obama and prior work indicates that racial attitudes and attitudes toward Obama are highly predictive of Affordable Care Act attitudes (Tesler, 2012). This final item scales well with the other 8 items and the Cronbach Alpha would go down from 0.89 to 0.87 if it was not included in the scale. Also, all of the multivariate analyses were performed on the scale excluding this item and there were no differences in the results.

9 It is important to note that this sample is quite small. Other studies of gender gaps find a range of gaps from 5 to 14 percentage points. In a larger sample of about 1000 respondents, such a gap is highly significant. This is not the case in this data because the sample size is considerably smaller leaving only a marginally significant gender gap.

10 There are no meaningful or substantial changes to the coefficients listed in Model 4 of Table 3 when humanitarian values or income are included separately rather than simultaneously.