Fowler, Gollust ’01 Author Paper on Insurance Enrollment, Advertising

Associate Professor of Government Erika Franklin Fowler is an author of a new paper released in HealthAffairs examining the link between health insurance changes after the first Affordable Care Act (ACA) open enrollment period and the efforts of federal, state, and non-profit sponsors to market their products.

Fowler and her co-authors found that advertising worked—more ads for the ACA produced a significantly higher rate of insurance enrollment.

The study, conducted in collaboration with researchers at the University of Minnesota (including Sarah Gollust ’01), uses advertising and television news data from the Wesleyan Media Project. It is one of the key papers to come out of a Robert Wood Johnson Foundation State Health Access Reform Evaluation (SHARE) grant for Wesleyan/University of Minnesota, on which Gollust is principal investigator and Fowler is co-PI.

The researchers considered the relationship between the volume of television insurance advertising in a given area during this time period and the area’s rate of uninsurance and Medicaid coverage before and after open enrollment (ie. In 2013 and 2014). They found that 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 advertising 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. Furthermore, state-sponsored insurance ads had the strongest relationship with declines in uninsurance from 2013 to 2014, compared to ads from private, federal, and other sponsors. An increase of 1,000 state-sponsored insurance ads was associated with a 0.23 percentage-point reduction in uninsurance.

The researchers emphasized the particular importance of state-sponsored insurance advertisements in driving coverage improvements. They calculated that roughly 2.5 people gained insurance for every state-sponsored ad aired during the first open enrollment period, and that doubling this advertising would lead to a 1.19 percent reduction in the uninsured. While strategic investment in advertising will be important to increase the uptake of insurance going forward, the authors stress that the type of advertising might affect the responsiveness of consumers.

“Although Republican control of government and the recent American Health Care Act proposal brings much uncertainty to the ACA’s future, insurance advertising will remain an important feature of encouraging enrollment in any marketplace,” said Fowler.