‘‘Simply un-American’’: Nativism and Support
for Health Care Reform
Benjamin R. Knoll
Published online: 21 December 2013
Ó Springer Science+Business Media New York 2013
Abstract 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 rela-
tionship 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 demon-
strates 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.
Keywords Nativism Á Cultural threat Á Health care reform Á Affordable
Care Act Á Elite framing
A previous version of this article was prepared for presentation at the 2012 American Political Science
Association Conference. We are also indebted to Nicholas Martini, Jason Ambrosius, Daniel Bowen,
Fred Boehmke, and Jennifer Mansﬁeld for their very helpful comments and suggestions.
B. R. Knoll (&)
Department of Politics, Centre College, Danville, KY, USA
Centre College, Danville, KY, USA
Polit Behav (2015) 37:87–108