Abstract
BackgroundThe rate of uninsured people has decreased dramatically since the Affordable Care Act was passed. To make an informed decision, consumers need assistance to understand the advantages and disadvantages of health insurance plans. The Show Me Health Plans Web-based decision support tool was developed to improve the quality of health insurance selection. In response to the promising effectiveness of Show Me Health Plans in a randomized controlled trial (RCT) and the growing need for Web-based health insurance decision support, the study team used expert recommendations for dissemination and implementation, engaged external stakeholders, and made the Show Me Health Plans tool available to the public.ObjectiveThe purpose of this study was to implement the public dissemination of the Show Me Health Plans tool in the state of Missouri and to evaluate its impact compared to the RCT.MethodsThis study used a cross-sectional observational design. Dissemination phase users were compared with users in the RCT study across the same outcome measures. Time spent using the Show Me Health Plans tool, knowledge, importance rating of 9 health insurance features, and intended plan choice match with algorithm predictions were examined.ResultsDuring the dissemination phase (November 2016 to January 2017), 10,180 individuals visited the SMHP website, and the 1069 users who stayed on the tool for more than one second were included in our analyses. Dissemination phase users were more likely to live outside St. Louis City or County (P<.001), were less likely to be below the federal poverty level (P<.001), and had a higher income (P=.03). Overall, Show Me Health Plans users from St. Louis City or County spent more time on the Show Me Health Plans tool than those from other Missouri counties (P=.04); this association was not observed in the RCT. Total time spent on the tool was not correlated with knowledge scores, which were associated with lower poverty levels (P=.009). The users from the RCT phase were more likely to select an insurance plan that matched the tool’s recommendations (P<.001) compared with the dissemination phase users.ConclusionsThe study suggests that a higher income population may be more likely to seek information and online help when making a health insurance plan decision. We found that Show Me Health Plans users in the dissemination phase were more selective in the information they reviewed. This study illustrates one way of disseminating and implementing an empirically tested Web-based decision aid tool. Distributing Web-based tools is feasible and may attract a large number of potential users, educate them on basic health insurance information, and make recommendations based on personal information and preference. However, using Web-based tools may differ according to the demographics of the general public compared to research study participants.
Highlights
We estimate that the provisions of the Affordable Care Act (ACA) have resulted in gains in health insurance coverage for 20.0 million adults through early 2016, a 2.4 million increase since our previous estimate in September 2015.1 These estimated health insurance coverage gains are shared broadly across population groups
Coverage gains for nonelderly adults were broadly shared among racial and ethnic groups. o The uninsured rate among Black non-Hispanics dropped by 11.8 percentage points (a 52.7 percent decline) from 22.4 to 10.6 percent; corresponding to about 3 million Black nonelderly adults gaining coverage. o The uninsured rate among Hispanics dropped by 11.3 percentage points (a 27.0 percent decline) from 41.8 to 30.5 percent, corresponding to about 4 million Hispanic nonelderly adults gaining coverage. o The uninsured rate among White non-Hispanics dropped by 7.3 percentage points (a 50.7 percent decline) from 14.3 to 7.0 percent, corresponding to about 8.9 million White nonelderly adults gaining coverage
From the 2010 baseline periods through the start of Open Enrollment in October 2013, the uninsured rate for young adults declined from 34.1 percent to 26.7 percent, which translates to 2.3 million more young adults with coverage
Summary
This issue brief reviews the most recent survey and administrative information available about gains in health insurance coverage since the enactment of the Affordable Care Act (ACA) in 2010. Our estimate of a net reduction of 20.0 million uninsured adults is based on data from the National Health Interview Survey (NHIS) and from the Gallup-Healthways Well-Being Index (WBI). The Gallup-Healthways WBI shows a dramatic and steady decline in the uninsured rate since the 2012–2013 baseline period before the ACA’s major coverage provisions took effect. We rely on the Gallup-Healthways WBI survey for tracking the current rate of health insurance coverage because it provides the timeliest information. Other federal and non-governmental surveys of health insurance status show similar trends over this time period
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