--- - |2+ Objective There is significant research regarding health‐care preferences in other nations and racial preference for health‐care providers. However, minimal research examines health‐care reform preferences in the United States. Therefore, this study aims to fill this void by demonstrating how a subterranean agenda, or attitudes toward race that manifest themselves into policy, at least partially drove public opinion regarding the Affordable Care Act (ACA). Methods Drawing from a nationally representative sample in the 2012 Blair Center–Clinton School Poll, this study examines how various “subterranean” elements in addition to economic, demographic, sociological, ideological, regional, and conditional factors shaped attitudes toward the ACA. Results Testing multiple hypotheses, we found that a subterranean agenda shaped preferences for ACA along with various other factors, such as presidential approval, individuals' perception regarding the role of the federal government, ideology, feeling toward blacks, feeling toward the Tea Party, and a conditional effect between a person's financial status and feeling toward blacks. Conclusion Preference for ACA is complex and driven by a multitude of factors. Future studies should explore the dynamics of public opinion over time and other state‐level and temporally driven factors that may increase or decrease the probability of individuals supporting health‐care reform. - 'Social Science Quarterly, EarlyView. '