Advertisement

Race, Religion and Support for the Affordable Care Act

Abstract

Using Pew Research Center’s Voter Attitudes Survey from 2012, we assess the impact race has on the relationship between religious faith and worship attendance with support for the Affordable Care Act (ACA). We find that White Evangelicals, independent of partisan affiliation and social-demographic characteristics, are more likely than White Non-Evangelicals to reject the ACA. In addition, among Whites, support for the ACA weakens with increasing religious attendance, suggesting that responses to this law are shaped by experiences within religious settings. However, we find little evidence for religious faith or worship attendance associating with Black and Hispanic health-care policy attitudes.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Subscribe to journal

Immediate online access to all issues from 2019. Subscription will auto renew annually.

US$ 99

This is the net price. Taxes to be calculated in checkout.

Notes

  1. 1.

    We understand that all public opinion polls, Pew included, suffered declining response rates over the past 50 years. Between 1997 and 2018, the average telephone response rate at the Pew Research Center decline from 36 to 6% (Kennedy and Hartig 2019). However, this does not necessarily mean that the univariate responses in this survey are susceptible to response bias. Respondents in a 2017 Pew Research Poll were as likely to identify as Democrat, Republican, and Independent as respondents in the American National Election Studies and General Social Survey, both of which have response rates in the 70% range (Keeter et al. 2017). The Pew Study that we use attempts to correct for its lower response rates by weighting the sample based on the demographic statistics that are reported by the Census. We mention this because weighting data is an impactful means to reduce nonresponse bias (Dey 1997; Keeter et al. 2017).

  2. 2.

    See the appendix for full question wording of these measures.

  3. 3.

    We exclude “other races” (approximately 126 persons) from our analysis, as the data set does not contain further information about who is included in this group.

  4. 4.

    The following formula expresses the average treatment effect—a counterfactual causal effect—of the association between attending worship services and health care policy attitudes by estimating policy attitudes based on respondents being randomly assigned to attending worship services at least once a month and less than once a month. In the formula, E = average health care policy attitude of sample, Di  = variable of frequency of worship attendance, Yi  = policy attitude of respondent who attended worship services once a month or more, and Y0i  = policy attitude of respondent who attended worship services less than once a month. We replicated the same analyses with religious faith as the independent variable.

    \(E\left[ {Y_{ii} |D_{i} = \, 1} \right] - E\left[ {Y_{ii} |D_{i} = \, 0} \right] = E\left[ {Y_{1i} - Y_{0i} |D_{i} = 1} \right] = E\left[ {Y_{1i} - Y_{0i} } \right].\).

  5. 5.

    Because so few Blacks and Hispanics identify as secular or non-Christian, we combine these groups in the multivariate analyses of Tables 2 and 3.

References

  1. Abanes, Richard. 1996. American Militias: Rebellion, Racism & Religion. Westmont, IL: InterVarsity Press.

  2. AME Social Action Commission. 2016. “Quadrennial Report.” In African Methodist Episcopal Church. http://ame.streampoint.com/wp-content/uploads/2016/04/Social-Action-GC-Report-2016.pdf. Accessed 4 November 2019.

  3. Amstutz, Mark R. 2014. Evangelicals and American foReign Policy. Oxford: Oxford University Press.

  4. Artiga, Samantha, Kendal Orgera, and Anthony Damico. 2019. Changes in Health Coverage by Race and Ethnicity Since Implementation of the ACA, 2013–2017. In Kaiser Family Foundation. https://www.kff.org/disparities-policy/issue-brief/changes-in-health-coverage-by-race-and-ethnicity-since-implementation-of-the-aca-2013-2017/. Accessed 13 November 2018.

  5. Gasteier, Audrey Morse. 2018. With The Federal Individual Mandate Gone, States Might Step Up: Lessons from Massachusetts. In Health Affairs Blog. January 16. https://www.healthaffairs.org/do/10.1377/hblog20180108.464274/full/. Accessed 4 November 2019.

  6. Balmer, Randall. 2016. Evangelicalism in America. Waco, TX: Baylor University Press.

  7. Banks, Adelle M. 2014. Religious groups Play Key Role in Obamacare Insurance Sign-up. In Washington Post. March 20. https://www.washingtonpost.com/national/religion/religious-groups-play-key-role-in-obamacare-insurance-sign-up/2014/03/20/9158842a-b063-11e3-b8b3-44b1d1cd4c1f_story.html?utm_term=.f2dcd91da66f. Accessed 4 November 2019.

  8. Blanchard, Troy C. 2007. Conservative Protestant Congregations and Racial Residential Segregation: Evaluating the Closed Community Thesis in Metropolitan and Nonmetropolitan Counties. American Sociological Review 72(3): 416–433.

  9. Bobo, Lawrence, James R. Kluegel, and Ryan A. Smith. 1997. Laissez-Faire Racism: The Crystallization of a Kinder, Gentler, Antiblack Ideology. In Racial Attitudes in the 1990’s: Continuity and Change, ed. Steven A. Toch and Jack K. Martin. Westport, CT: Continuity and Change.

  10. Bread for the World. 2017. Christian Leaders Speak Out on Cassidy-Graham Health Care Bill. September 25. http://www.bread.org/news/christian-leaders-speak-out-cassidy-graham-health-care-bill. Accessed 4 November 2019.

  11. Brown, R. Khari. 2008. Racial/Ethnic Differences in Religious Congregation-Based Social Service Delivery Efforts. Journal of Sociology and Social Welfare 35: 95–113.

  12. Brown, R. Khari. 2009. Denominational Differences in Support for Race-Based Policies Among White, Black, Hispanic, and Asian Americans. Journal for the Scientific Study of Religion 48(3): 604–615.

  13. Brown, R. Khari, Angela Kaiser, and James S. Jackson. 2014. Worship Discourse and White Race-Based Policy Attitudes. Review of Religious Research 56(2): 291–312.

  14. Brown, Ronald E., R. Khari Brown, Davin Phoenix, and James S. Jackson. 2016. Race, Religion, and Anti-Poverty Policy Attitudes. Journal for the Scientific Study of Religion 55(2): 308–323.

  15. Buchmueller, Thomas C., Zachary M. Levinson, Helen G. Levy, and Barbara L. Wolfe. 2016. Effect of the Affordable Care Act on Racial and Ethnic Disparities in Health Insurance Coverage. American Journal of Public Health 106(8): 1416–1421.

  16. Charo, R.Alta. 2014. The Supreme Court Decision in the Hobby Lobby Case: Conscience, Complicity, and Contraception. Journal of the American Medical Association 174(10): 1537–1538.

  17. Craig, David M. 2014. Health Care as a Social Good: Religious Values and American Democracy. Washington, DC: Georgetown University Press.

  18. Dey, Eric L. 1997. Working with Low Survey Response Rates: The Efficacy of Weighting Adjustments. Research in Higher Education 38(2): 215–227.

  19. Du Bois, W.E.B. 1899. The Philadelphia Negro: A Social Study. Philadelphia: University of Pennsylvania Press.

  20. Emerson, Michael O., and Christian Smith. 2000. Divided by Faith: Evangelicalism and the Problem of Race in America. New York: Oxford University Press.

  21. Emerson, Michael O., Rachel Tolbert Kimbro, and George Yancey. 2002. Contact Theory Extended: The Effects of Prior Racial Contact on Current Social Ties. Social Science Quarterly 3: 745.

  22. Feagin, Joe R. 1975. Subordinating the poor: Welfare and American beliefs. Upper Saddle River, NJ: Prentice Hall.

  23. Franz, Berkeley. 2018. Encouraging Accountability: Evangelicals and American Health Care Reform. Critical Research on Religion 6(2): 184–204.

  24. Franz, Berkeley, Daniel Skinner, and Kelly Kelleher. 2016. What Should Churches Do? Evangelical Perspectives on Church Involvement in an Era of Community Health. Community Development 48(1): 2–18.

  25. Grant, Tobin. 2012. Most Evangelicals Likely to Lament Supreme Court Health Care Ruling. In Christianity Today. June 28. http://www.christianitytoday.com/ct/2012/juneweb-only/supreme-court-health-care-decision.html. Accessed 16 January 2013.

  26. Hall, Deborah L., David C. Matz, and Wendy Wood. 2019. Why Don’t We Practice What We Preach? A Meta-Analytic Review of Religious Racism. Personality and Social Psychology Review 14(1): 126–139.

  27. Han, Xinxin, Qian Luo, and Leighton Ku. 2017. Medicaid Expansion and Grant Funding Increases Helped Improve Community Health Center Capacity. Health Affairs 36(1): 49–56.

  28. Harrington, Scott E. 2010. U.S. Health Care Reform and the Patient Protection and Affordable Care Act. Journal of Risk and Insurance 77(3): 703–708.

  29. Hicken, Margaret T., Hedwig Lee, Jeffrey Morenoff, James S. House, and David R. Williams. 2014. Racial/Ethnic Disparities in Hypertension Prevalence: Reconsidering the Role of Chronic Stress. American Journal of Public Health 104(1): 117–123.

  30. Hinojosa, Victor J., and Jerry Z. Park. 2004. Religion and the Paradox of Racial Inequality Attitudes. Journal for the Scientific Study of Religion 43(2): 229.

  31. Hunsberger, B., and L.M. Jackson. 2005. Religion, Meaning, and Prejudice. Journal of Social Issues 61(4): 807–826.

  32. Hunt, Matthew O. 2000. Status, Religion, and the ‘Belief in a Just World’: Comparing African Americans, Latinos, and Whites. Social Science Quarterly 81(1): 325–343.

  33. Hunt, Matthew O. 2002. Religion, Race/Ethnicity, and Beliefs About Poverty. Social Science Quarterly 83(3): 810–831.

  34. Hymson, Edward B., and Oscar Javier Ornelas. 2016. A Critical Examination of the Individual Mandate and Business Mandate Provisions of the Affordable Care Act. Southern Law Journal 26(1): 79–116.

  35. Jackson, James S. (James Sidney), Vincent L. Hutchings, Ronald Brown, and Cara Wong. 2004. National Politics Study. In Inter-university Consortium for Political and Social Research, Ann Arbor, MI [distributor], 2009-03-23. https://doi.org/10.3886/ICPSR24483.v1.

  36. Kaiser Family Foundation. 2018a. 6 Charts About Public Opinion On The Affordable Care Act. December 19. https://www.kff.org/health-reform/poll-finding/6-charts-about-public-opinion-on-the-affordable-care-act/. Accessed 29 October 2018.

  37. Kaiser Family Foundation. 2018b. Key Facts about the Uninsured Population. December 7. https://www.kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/. Accessed 4 November 2019.

  38. Kaiser Health News. 2018. ACA’s Popularity Grows, Even as GOP Lauds Change to Requirement to Have Coverage. March 1. https://khn.org/news/acas-popularity-grows-even-as-gop-lauds-change-to-requirement-to-have-coverage/. Accessed 4 November 2019.

  39. Keeter, Scott, Nick Hatley, Courtney Kennedy, and Arnold Lau. 2017. What Low Response Rates Mean for Telephone Surveys: Telephone polls still provide accurate data on a wide range of social, demographic and political variables, but some weaknesses persist. Pew Research Center. May 15. https://www.pewresearch.org/methods/2017/05/15/what-low-response-rates-mean-for-telephone-surveys/. Accessed 5 May 2019.

  40. Kennedy, Courtney, and Hartig, Hannah. 2019. Response rates in telephone surveys have resumed their decline. Pew Research Center. February 27. https://www.pewresearch.org/fact-tank/2019/02/27/response-rates-in-telephone-surveys-have-resumed-their-decline/.

  41. Kershaw, Kiarri N., Whitney R. Robinson, Penny Gordon-Larsen, Margaret T. Hicken, David C. Goff, Mercedes R. Carnethon, Catarina I. Kiefe, Stephen Sidney, and Ana V. Diez Roux. 2017. Association of Changes in Neighborhood-Level Racial Residential Segregation with Changes in Blood Pressure Among Black Adults: The CARDIA Study. Journal of the American Medical Association 177: 996–1002. https://doi.org/10.1001/jamainternmed.2017.1226.

  42. Kluegel, James, and Eliot Smith. 1986. Beliefs about Inequality: What Is and Ought to Be. New York: Aldine de Gruyter.

  43. Lloyd, Vincent W., and Andrew Prevot (eds.). 2018. Anti-Blackness and Christian Ethics. Maryknoll, NY: Orbis Books.

  44. McDaniel, Eric. 2003. Black Clergy in the 2000 Elections. Journal for the Scientific Study of Religion 42: 533–546. https://doi.org/10.1046/j.1468-5906.2003.00201.x.

  45. McKenzie, Brian D., and Stella M. Rouse. 2012. Shades of Faith: Religious Foundations of Political Attitudes Among African Americans, Latinos, and Whites. American Journal of Political Science 57(1): 218–235.

  46. Medina-Inojosa, J., Nathalie Jean, Mery Cortes-Bergoderi, and Francisco Lopez-Jimeneza. 2014. The Hispanic Paradox in Cardiovascular Disease and Total Mortality. Progress in Cardiovascular Diseases 57(3): 286–292.

  47. Mikati, Ihab, Adam F. Benson, Thomas J. Luben, Jason D. Socks, and Jennifer Richmond-Bryant. 2018. Disparities in Distribution of Particulate Matter Emission Sources by Race and Poverty Status. American Journal of Public Health 108(4): 480–485.

  48. National Association of Evangelicals. 1994. Resolution: Health Care Reform. https://www.nae.net/health-care-reform/. Accessed 4 November 2019.

  49. National Association of Evangelicals. 2009. NAE Calls for Civility in Health Care Reform Debate. August 19. https://www.nae.net/nae-calls-for-civility-in-health-care-reform-debate/. Accessed 4 November 2019.

  50. National Council of Churches. 1999. Resolution: Resolution For Renewed Faith Community Universal Health Care Campaign. http://nationalcouncilofchurches.us/common-witness/1999/health-care.php. Accessed 4 November 2019.

  51. National Council of Churches. 2017. Statement by Major Christian Organizations on President-Elect Trump’s Policy Agenda and Political Appointments. January 6. https://nationalcouncilofchurches.us/statement-by-major-christian-organizations-on-president-elect-trumps-policy-agenda-and-political-appointments/. Accessed 4 November 2019.

  52. Padilla, Yolanda C., Erin R. Hamilton, and Robert A. Hummer. 2009. Beyond the Epidemiological Paradox: the Health of Mexican–American Children at Age Five. Social Science Quarterly 90(5): 1072–1088.

  53. Pettigrew, Thomas F., and Linda R. Tropp. 2008. How Does Intergroup Contact Reduce Prejudice? Metaanalytic Tests of Three Mediators. European Journal of Social Psychology 38(6): 922–934.

  54. Pew Research Center. 2017. Among White Evangelicals, Regular Churchgoers are the Most Supportive of Trump. April 26. http://www.pewresearch.org/fact-tank/2017/04/26/among-White-evangelicals-regular-churchgoers-are-the-most-supportive-of-trump/. Accessed 4 November 2019.

  55. Portes, Alejandro, and Ruben G. Rumbaut. 2001. Legacies: The Story of the Immigrant Second Generation. Berkeley: University of California Press.

  56. PRRI (Public Religion Research Institute). 2013. PRRI/Brookings 2013 Economic Values Survey. https://www.prri.org/data-vault/?topic%5B%5D=&meta_year%5B%5D=2013. Accessed 1 March 2019.

  57. PRRI (Public Religion Research Institute). 2015. June 2015 Survey. https://www.prri.org/data-vault/?topic%5B%5D=&meta_year%5B%5D=2015. Accessed 1 March 2019.

  58. Putnam, Robert D. 2012. American Grace: How Religion Divides and Unites Us. New York: Simon & Schuster.

  59. Rigby, Elizabeth, Jennifer Hayes Clark, and Stacey Pelika. 2014. Party Politics and Enactment of ‘Obamacare’: A Policy-Centered Analysis of Minority Party Involvement. Journal of Health Politics, Policy and Law 39(1): 57–95.

  60. Smidt, Corwin. 2009. The Cooperative Clergy Study Project of 2009. http://www.thearda.com/Archive/Files/Descriptions/COOPCL09.asp. Accessed 4 November 2019.

  61. Smidt, Corwin, et al. 2010. The Disappearing God Gap? Religion in the 2008 Presidential Election. Oxford: Oxford University Press.

  62. Speights, Joedrecka S., Samantha S. Brown, Brittny A. Goldfarb, Leslie Beitsch Wells, Robert S. Levine, and George Rust. 2017. State-Level Progress in Reducing the Black–White Infant Mortality Gap, United States, 1999–2013. American Journal of Public Health 107(5): 775–782.

  63. Steensland, Brian, and Eric L. Wright. 2014. American Evangelicals and Conservative Politics: Past, Present, and Future. Sociology Compass 8(5): 705–717.

  64. Swidler, Ann. 1986. Culture in Action: Symbols and Strategies. American Sociological Review 51: 273–286.

  65. Taylor, Marylee C., and Stephen M. Merino. 2011. Race, Religion, and Beliefs about Racial Inequality. The Annals of the American Academy of Political and Social Science 634(1): 60–77.

  66. Teruya, Stacey A., and Shahrzad Bazargan-Hejazi. 2013. The Immigrant and Hispanic Paradoxes: A Systematic Review of Their Predictions and Effects. Hispanic Journal of Behavioral Sciences 35: 486–509.

  67. Tranby, Eric, and Douglas Hartmann. 2008. Critical Whiteness Theories and the Evangelical ‘Race Problem’: Extending Emerson and Smith’s Divided by Faith. Journal for the Scientific Study of Religion 47(3): 341–359.

  68. Voigt, Kristin. 2013. Appeals to Individual Responsibility for Health: Reconsidering the Luck Egalitarian Perspective. Cambridge Quarterly of Healthcare Ethics 22(2): 146–158.

  69. Wilcox, Clyde, and Carin Robinson. 2009. Onward Christian Soldiers? The Religious Right in American Politics. Boulder, CO: Westview Press.

  70. Williams, David R., and Michelle Sternthal. 2010. Understanding Racial-ethnic Disparities in Health: Sociological Contributions. Journal of Health and Social Behavior 51(1_suppl): S15–S27. https://doi.org/10.1177/0022146510383838.

  71. Yancey, George. 1999. An Examination of the Effects of Residential and Church Integration on Racial Attitudes of Whites. Sociological Perspectives 42(2): 279–304.

  72. Yancey, George, and Michael Emerson. 2003. Integrated Sundays: An Exploratory Study into the Formation of Multiracial Churches. Sociological Focus 36(2): 111.

Download references

Acknowledgements

None.

Funding

None to report.

Author information

Correspondence to R. Khari Brown.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendix

Appendix

See the Table 4.

Table 4 Full survey questions on the Affordable Care Act

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Franz, B., Brown, R.K. Race, Religion and Support for the Affordable Care Act. Rev Relig Res (2020). https://doi.org/10.1007/s13644-020-00396-0

Download citation

Keywords

  • Religion
  • Race/ethnicity
  • Affordable Care Act
  • Politics
  • Health care reform