Abstract
BackgroundReductions in health insurance enrollment outreach could have negative effects on the individual health insurance market. Specifically, consumers may not be informed about the availability of coverage, and if some healthier consumers fail to enroll, there could be a worse risk pool for insurers. Kentucky created its own Marketplace, known as kynect, and adopted Medicaid expansion under the Affordable Care Act, which yielded the largest decline in adult uninsured rate in the United States from 2013 to 2016. The state sponsored an award-winning media campaign, yet after the election of a new governor in 2015, it declined to renew the television advertising contract for kynect and canceled all pending television ads with over a month remaining in the 2016 open enrollment period.ObjectiveThe objective of this study is to examine the stark variation in television advertising across multiple open enrollment periods in Kentucky and use this variation to estimate the dose-response effect of state-sponsored television advertising on consumer engagement with the Marketplace. In addition, we assess to what extent private insurers can potentially help fill the void when governments reduce or eliminate television advertising.MethodsWe obtained television advertising (Kantar Media/Campaign Media Analysis Group) and Marketplace data (Kentucky Health Benefit Exchange) for the period of October 1, 2013, through January 31, 2016, for Kentucky. Advertising data at the spot level were collapsed to state-week counts by sponsor type. Similarly, a state-week series of Marketplace engagement and enrollment measures were derived from state reports to Centers for Medicare and Medicaid Services. We used linear regression models to estimate associations between health insurance television advertising volume and measures of information-seeking (calls to call center; page views, visits, and unique visitors to the website) and enrollment (Web-based and total applications, Marketplace enrollment).ResultsWe found significant dose-response effects of weekly state-sponsored television advertising volume during open enrollment on information-seeking behavior (marginal effects of an additional ad airing per week for website page views: 7973, visits: 390, and unique visitors: 388) and enrollment activity (applications, Web-based: 61 and total: 56).ConclusionsState-sponsored television advertising was associated with nearly 40% of unique visitors and Web-based applications. Insurance company television advertising was not a significant driver of engagement, an important consideration if cuts to government-sponsored advertising persist.
Highlights
In late August 2017, the Trump administration announced plans to cut federal funding for Marketplace advertising by 90% for the 2018 open enrollment period, including the elimination of all television advertising [1]
State-sponsored television advertising was associated with nearly 40% of unique visitors and Web-based applications
This was the latest upheaval for the Affordable Care Act (ACA) in a tumultuous first year of the Trump presidency, which included an executive order to “minimiz[e] the economic burden” of the law, unplanned advertising reductions at the end of the 2017 open enrollment period, failed legislative efforts to repeal and replace, shortening of the open enrollment period, cuts to enrollment assistance, discontinuation of cost-sharing reduction payments, and a repeal of the individual mandate included in the tax bill signed into law in December [2,3,4,5,6]
Summary
In late August 2017, the Trump administration announced plans to cut federal funding for Marketplace advertising by 90% for the 2018 open enrollment period, including the elimination of all television advertising [1]. The Marketplace, as the combination of state-based and federally run health insurance exchanges created by the ACA is known, provides consumers with the opportunity to compare plans, determine eligibility for financial assistance and Medicaid, and enroll in coverage. Among a sample of low-income adults in Arkansas, Kentucky, and Texas, those reporting greater exposure to positive advertising about the law were significantly more likely to say that the “ACA helped me” [8]. In a nationally representative sample, those with higher volumes of insurance-related advertising in their media market were significantly more likely to report feeling informed about the ACA and have more positive views of the law [9]. The state sponsored an award-winning media campaign, yet after the election of a new governor in 2015, it declined to renew the television advertising contract for kynect and canceled all pending television ads with over a month remaining in the 2016 open enrollment period
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