Assessing the Content of Television Health Insurance Advertising during Three Open Enrollment Periods of the ACA

Abstract

Television advertising has been a primary method for marketing new health plans available under the Affordable Care Act (ACA) to consumers. Kantar Media/CMAG data were used to analyze advertising content during three ACA open enrollment periods (2013-2016). Few advertisement airings featured people who were elderly, disabled, or receiving care in a medical setting, and airings increasingly featured children, young adults and people exercising overtime. The most common informational messages focused on plan choice and availability of low-cost plans, but messages shifted over open enrollment cycles to emphasize avoidance of tax penalties and availability of financial assistance. Over the three open enrollment periods, there was a sharp decline in explicit mentions of the ACA or Obamacare in advertisements. Overall, television advertisements have increasingly targeted young, healthy consumers and informational appeals have shifted toward a focus on financial factors in persuading individuals to enroll in Marketplace plans. These advertising approaches make sense in the context of pressures to market plans to appeal to a sufficiently large, diverse group. Importantly, dramatic declines over time in explicit mention of the law mean that citizens may fail to understand the connection between the actions of government and the benefits they are receiving.

Competing Public and Private Television Advertising Campaigns and Marketplace Enrollment for 2015 to 2018

“…As Republicans fight the ACA, we might expect other sponsors to submerge the role (that is, hide mentions) of the ACA in their advertisements. We see indications of this submerging in data from the first three open enrollment periods, where 49 percent of ads mentioned the ACA in the first open enrollment period but only 31 percent in the second and third (Barry et al 2018). There is likely an interaction between different types of communication, with the political communication strategies shaping insurer strategies, and vice versa.…”

“…This decline in reported exposure, despite the high volumes of private advertising (as noted in figure 4), may indicate that consumers did not perceive the increased presence of private advertising as a share of all health insurance ads as providing ACA-specific information as much as government-sponsored ads do. Indeed, references to the ACA in all insurance ads aired declined between 2013 and 2016 (Barry et al 2018) and in insurance-company sponsored ads in particular .…”

“…Advertisements aired on national cable channels and local broadcast networks are also an important source of information and still a channel for reaching most Americans (Bialik and Matsa 2017;Pew Research Center 2018). Television advertising for health insurance includes not only federal and state advertising for the Marketplace but also advertising sponsored by insurance companies and nonprofit organizations for products that may or may not be available on the Marketplace, such as off-exchange plans, employer-sponsored coverage, Medicare supplement, and Medicare Advantage (Barry et al 2018;Gollust et al 2014;. Political ads taking positions on the ACA-predominantly anti-ACA attacks in the earlier years-were also directly competing for air time with health insurance advertising during the fall open enrollment cycles that coincided with election years: 2014, 2016, and 2018 Fowler, Baum, Barry, et al 2017;Fowler and Ridout 2014;Fowler, Franz, and Ridout 2018).…”

Characterization of US Hospital Advertising and Association With Hospital Performance, 2008-2016

“…The data have been used in previous studies examining advertising in health care. 3,9,19 Designated market areas consist of groups of counties surrounding metropolitan areas and were developed by Nielsen Holdings (a data and market measurement company) to track television viewership. Media advertising is typically purchased at the DMA level.…”

Political Science and U.S. Health Policy in the Era of the Affordable Care Act

“…As messages that confronted consumers varied significantly regionally, advertising and news coverage potentially affected perception of the rollout of the ACA early on. Interestingly, research has also shown that the political content during open enrollment seasons declined significantly over time, as insurers began to focus more on the promotion of enrollment and plan benefits, for example (Barry et al, ).…”