The Pathways of Policy Feedback: How Health Reform Influences Political Efficacy and Participation

Lawrence R. Jacobs, Suzanne Mettler, Ling Zhu

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


How do policy feedback effects occur? A growing number of rigorous empirical studies provide evidence that new policies can, indeed, stimulate new politics, such as increased political participation among citizens, but greater understanding is needed of the underlying mechanisms and long-term policy feedback effects. This paper puts forth a dynamic theory of the mechanisms through which policy experiences may influence political participation, focusing particularly on political efficacy. We use five waves of panel data collected over 8 years to investigate the impact of the Affordable Care Act (ACA), controlling for pre-existing ideology and socio-economic and demographic factors. We analyze the impact of resource and interpretive effects and disentangle direct and indirect effects. We find that the ACA has elevated Americans’ political efficacy and political participation with large and enduring effects, and we show the pathways through which this has occurred.

Original languageEnglish (US)
Pages (from-to)483-506
Number of pages24
JournalPolicy Studies Journal
Issue number3
StatePublished - Mar 16 2021

Bibliographical note

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© 2021 Policy Studies Organization


  • ACA
  • efficacy
  • policy feedback
  • political participation


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