“Simply un-American”: Nativism and Support for Health Care Reform


This study investigates the relationship between individual-level support for the 2010 Affordable Care Act and nativism, the perception that a traditional American culture and way of life needs to be protected against foreign influence. The results of an analysis of a 2011 public opinion survey demonstrate that nativism was an independent and significant predictor of opposition to health care reform and that this effect held for both Republicans as well as Democrats, although the relationship is stronger for Republicans. This is substantively important for two reasons. First, it demonstrates that certain sub-groups of the American public evaluate public policy proposals on the basis of their perceived “foreignness.” Second, it demonstrates that while nativism is traditionally associated with immigration and other race/ethnic-based policy preferences, it also affects attitudes toward other seemingly race-neutral policies in the United States.

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Fig. 1


  1. 1.

    It should be noted that framing an issue as “un-American” does not necessarily imply in every case a nativist judgment on the part of the message’s framer. A quick internet search of the phrase “un-American” quickly reveals how commonly and diversely this phrase has come to be used in modern political rhetoric. At the same time (and importantly for our study), the phrase “un-American” can certainly cue nativist responses on the part of the message’s recipients regardless of the intention of the message’s sender/framer.

  2. 2.

    We also estimated these models using a multinomial logit estimator as well as the original ordinal logit estimator. Both estimations produced the same substantive results for the key independent variables as presented here in Table 3.

  3. 3.

    This is a similar approach to that employed by Kam and Kinder (2012) in their analysis of the mediating effects of racial resentment and religious intolerance on the relationship between ethnocentrism and evaluations of President Obama.


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Knoll, B.R., Shewmaker, J. “Simply un-American”: Nativism and Support for Health Care Reform. Polit Behav 37, 87–108 (2015). https://doi.org/10.1007/s11109-013-9263-z

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  • Nativism
  • Cultural threat
  • Health care reform
  • Affordable Care Act
  • Elite framing