A paper released today in Health Affairs examines the link between health insurance changes after the first ACA open enrollment period (“OEP One”) and the efforts of federal, state, and non-profit sponsors to market their products. Specifically, the study authors considered the relationship between the volume of television insurance advertising in a given area during OEP One and the area’s rates of uninsurance and Medicaid coverage before and after open enrollment (i.e., in 2013 and 2014).
The analysis, led by Dr. Pinar Karaca-Mandic (University of Minnesota), is part of a larger SHARE-funded study led by Dr. Sarah Gollust (University of Minnesota) and Dr. Erika Franklin Fowler (Wesleyan University) looking at the relationship between ACA-related media messages and insurance enrollment.
Data & Methods
The authors estimated multivariate regression models using two sources of data: (1) county-level insurance coverage data from the 2013 and 2014 American Community Survey (ACS) and (2) data on the volume of health insurance product advertisements at the Nielsen Designated Market Area (DMA; composed of counties) from Kantar Media/Campaign Media Analysis Group (CMAG) through the Wesleyan Media Project.
Key Findings
Uninsurance and Advertising
- For the counties for which ACS estimates were available for both 2013 and 2014, the percentage of the population younger than age 65 that lacked health insurance fell by an average of 2.9 percentage points between the two time periods.
- Counties with larger advertisement volumes saw larger declines in uninsurance than other counties: For every increase of 1,000 insurance advertisements there was a 0.1 percentage-point reduction in uninsurance.
- State-sponsored insurance advertisements had the strongest relationship with declines in uninsurance from 2013 to 2014 (compared to advertisements from private, federal, and other sponsors): An increase of 1,000 state-sponsored insurance advertisements was associated with a 0.23 percentage-point reduction in uninsurance.
Medicaid Coverage and Advertising
- For the sample counties, the percentage of the population younger than age 65 that was enrolled in Medicaid increased by 1.3 percentage points on average between 2013 and 2014.
- There was no association between overall volume of advertisements and Medicaid enrollment.
- An increase in privately-sponsored advertisements was associated with a reduction in Medicaid coverage between 2013 and 2104.
- An increase in state-sponsored advertisements was associated with an increase in Medicaid coverage, as was an increase in the volume of “other” advertisements (e.g., those sponsored by enrollment advocates and public service announcements).
Discussion
In light of these findings, the researchers emphasize the particular importance of state-sponsored insurance advertisements in driving coverage improvements. They calculate that roughly 2.5 people gained insurance for every state-sponsored advertisement aired during the first ACA open enrollment period and that doubling state-sponsored advertisements would lead to a 1.19 percent reduction in the uninsured. While strategic investment in advertising will be important to increase the uptake of health insurance going forward, the authors stress that the type of advertising might affect the responsiveness of consumers.