We convened three two-hour focus groups in September 2017, with a total of 30 Americans in three locations across the country. The groups were conducted in urban Hamilton County, Ohio, where Cincinnati is located; rural Franklin County, Missouri; and suburban Suffolk County, New York. Locations were identified based on several factors, including that Ohio and New York both expanded Medicaid under the ACA but Missouri did not. Locations were also chosen for their voting histories: Hamilton County is located in Ohio, which has historically been a swing state in presidential elections. Franklin County is located in Missouri, which has voted for the eventual winner of all but three presidential elections. Suffolk County, New York, supported Donald Trump in the 2016 presidential election after Barack Obama won the county in the 2008 and 2012 elections.

In all groups, participants were recruited by professional market research firms according to Public Agenda’s specifications to represent a cross section of the public in those counties in terms of gender, age, socioeconomic status, health insurance status, race/ethnicity and political ideology. During recruitment, potential participants were asked whether they or anyone in their household worked in the health care industry. People who answered affirmatively were not included in the groups. Focus groups took place in market research facilities, and all participants were compensated for their time. Senior Public Agenda staff moderated the focus groups. Focus groups were video recorded and professionally transcribed. Public Agenda’s research team collaboratively developed a coding scheme and coded the focus group transcripts using Dedoose qualitative analysis software.