According to an article released in Health Affairs, people living in counties with higher numbers of television advertisements sponsored by the federal government were significantly more likely to shop for and enroll in a Marketplace plan. Sarah Gollust of the University of Minnesota, School of Public Health was the lead author of this analysis, which was funded through Dr. Gollust’s SHARE grant. The paper was co-authored by Andrew Wilcock (Harvard Medical School), Erika Franklin Fowler (Wesleyan University), Colleen Barry (Johns Hopkins Bloomberg School of Public Health), Jeff Neiderdeppe (Cornell University), Laura Baum (Wesleyan University), and Pinar Karaca-Mandic (University of Minnesota).
Overview: Effectiveness of Health Insurance Advertising
The effectiveness of health insurance advertising has gained renewed attention following reductions to the marketing budget for the federal Marketplace, but there is limited evidence on the relationship between advertising and enrollment behavior. Dr. Gollust and her co-authors combined survey data from the 2014 National Health Interview Survey (NHIS) on adults ages 18–64 with data on volumes of televised advertisements aired in respondents’ counties of residence during the 2013–2014 open enrollment period to study whether the volumes of televised content were associated with the shopping and enrollment behavior of U.S. adults in the new health insurance Marketplaces in 2014.
Key Findings
The researchers found that people living in counties with higher numbers of ads sponsored by the federal government during the 2013-2014 open enrollment period were significantly more likely to shop for and enroll in a Marketplace plan in 2014. On the other hand, people living in counties with higher numbers of political ads opposing the ACA were less likely to shop for or enroll in a Marketplace plan.
Shopping for a Marketplace Plan
According to the analysis, the probability of shopping for a plan on the Marketplace was 13.4% in counties in the tenth percentile of volume of federal ads, compared to 16.2% in counties in the ninetieth percentile. Conversely, the probability of shopping for a Marketplace plan was 14.2% in counties in the tenth percentile of volume of political ads, compared to 12.9% in counties in the ninetieth percentile.
Enrolling in a Marketplace Plan
Similarly, the probability of enrolling in a Marketplace plan was 3.7% for respondents in counties with median volumes of federal ads, compared with 5.2% for respondents in counties in the ninetieth percentile. In contrast, the probability of enrolling in a Marketplace plan was 4.5% in counties in the tenth percentile of volume for political ads, compared to 3.3% in counties in the ninetieth percentile.
Policy Implications
This study shows that advertising efforts are likely an important component of health insurance enrollment campaigns. The authors note, however, that these findings might not extrapolate to the 2018 enrollment period, when 11.8 million Americans enrolled in HealthCare.gov plans despite federal cuts to all television advertising. These findings are from a period when the ACA was new, during which time advertising from all sponsors may have played a particularly important role and during which time the messaging was likely different.
Learn More
Read the full Health Affairs article to learn more about study methods, findings, and policy implications.