Before the Affordable Care Act (ACA), Americans' opinions on health policy were largely driven by symbolic politics. However, this new analysis questions whether self-interest becomes more significant when faced with costly actions under the ACA.

Using Gallup's monthly tracking poll data from over one million respondents between 2014 and early 2018, we explore how symbolic vs. material interests influence health insurance decisions during enforcement periods.

Symbolic Views Prevail in Public Opinion: Our analysis of polling data reveals that even when faced with ACA penalties or mandates, most Americans base their policy opinions on abstract values rather than personal financial calculations.

Self-Interest Matters in Behavior Change: But we also find evidence suggesting self-interest does play a role at the individual decision-making level regarding health insurance purchases.

What This Means for Political Science: The findings indicate that while symbolic politics dominates public discourse about healthcare, material incentives may be more influential when citizens actually engage with their benefits.➤ Gallup➤ ACA Enforcement