Abstract Introduction Social media’s pervasive role in daily life provides a unique avenue for understanding public sentiments. This study utilizes YouTube comments on an MSNBC video about the Affordable Care Act (ACA) to explore public opinions on the policy and its political implications. Methods A qualitative analysis of YouTube comments on an MSNBC video was conducted. Netlytic, a scraping tool, gathered 1,949 comments. Thematic analysis, based on a coding framework derived from Semetko and Valkenburg’s frames, identified three predominant frames: Responsibility, Human Interest, and Economic Consequences. Results Of the 1949 comments posted in response to the ACA video on YouTube, 488 were analyzed. Three media frames were used to categorize the comments. Among the analyzed comments, 42% fell within the Responsibility Frame, indicating that 205 comments attributed responsibility for ACA-related issues, healthcare access, and costs to political parties, individual politicians, and government entities. The Human-Interest Frame accounted for 11% of the comments, with 53 remarks reflecting individual experiences related to healthcare access and costs. Additionally, 26% of the comments fell within the Economic Consequences Frame, signifying those 125 comments included remarks concerning the economic impacts of the ACA, such as increased healthcare access, taxes, and penalties. The remaining 21% of comments did not align with the three frames. Conclusions This study embarked on a comprehensive exploration of public discourse surrounding the Affordable Care Act (ACA) within the context of the 2024 presidential election, utilizing YouTube comments as a rich source of qualitative data. Through a meticulous methodological approach, which included thematic framing analysis and intercoder reliability assessments, valuable insights into the diverse perspectives and sentiments expressed by social media users regarding this critical healthcare legislation were gained. Key messages • Social media allows for real-time understanding of people’s thoughts, beliefs, opinions, and ideas, as well as serves as a useful tool that fosters broad, unfiltered data/content. • Researchers conducted a qualitative analysis of public discourse on YouTube to explore the range of sentiments regarding the ACA.