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

Abstract

The Affordable Care Act was a landmark political achievement in reforming the American health insurance system but has been subject to considerable political pressure. Administrative actions, such as eliminating federal advertising, have served as a replacement for failed legislative repeal efforts. We use a county-level fixed-effects model with data for thirty-four states for the 2015 to 2018 open enrollment periods to measure dose-response relationships between health insurance and health-care-related political advertising and Marketplace enrollment. State-sponsored advertising is related to greater Marketplace enrollment, but we find no association between federal advertising and enrollment. We are, however, unable to account for the endogeneity of advertising decisions across media markets and potential federal coordination with other sponsor types. These results have implications for understanding public roles within privatized policy implementation.

Association of Funding Cuts to the Patient Protection and Affordable Care Act Navigator Program With Privately Sponsored Television Advertising

“…Funding Cuts to the ACA Navigator Program and Privately Sponsored Television Advertising people in marketplace coverage, advertising may be a substitute for public funding of the navigator program, albeit an imperfect one. Despite evidence of the association between outreach and health insurance enrollment, including direct enrollment assistance via navigators 25,[34][35][36] and television advertising, 16,24,[37][38][39][40] little research has explored the interplay between public and private sector sources of outreach. To assess the repercussions of recent developments and inform policy decisions, this study examined the association between the Trump-era cuts in navigator program funding and the volume of private sector advertising.…”

“…We used a method described in previous work to categorize advertisements by whether they were privately sponsored and by product category (Medicare, Medicaid, and private non-Medicare, non-Medicaid; the final category included marketplace, non-ACA-compliant plans, and employer-sponsored coverage). 16 In addition, advertisements were categorized according to the open enrollment period in which they aired. Open enrollment periods begin in the autumn before the plan year, which starts on January 1, and end either in the December before the plan year or at some point early in the plan year.…”

“…9,10 Complex choices and the large number of available options increase the difficulty of selecting a marketplace plan. [11][12][13][14][15] To address these information barriers and increase marketplace coverage, public and private sector entities have conducted outreach ranging from advertising 16,17 to direct enrollment assistance. 18 Since 2014, each state was required to establish assister programs providing free, impartial, one-on-one advice and enrollment assistance.…”

“…23 During the Trump administration, public sector outreach efforts changed in several ways relevant to marketplace enrollment. 16,[24][25][26] After the inauguration, the Trump administration canceled the television and radio advertising scheduled for the final week of the 2017 open enrollment period. 27 Just before the beginning of the 2018 open enrollment period, the administration eliminated all federal funding for television advertising for the marketplace and reduced marketing funding by 90%.…”

Health Insurance Ad Messages Targeted to English- and Spanish-Speaking Populations in a Period of Limited Federal Investment in Marketplace Outreach

“…Specifically, research examining the first open-enrollment period of the ACA (2013–2014) identified aggregate associations between the volume of insurance ads aired on TV to county-level insurance gains generally and Medicaid enrollment gains in particular (Karaca-Mandic et al, 2017); at the individual level, higher volumes of advertising exposure were also associated with insurance-related outcomes in 2014 (Gollust, Wilcock, et al, 2018). Subsequent research examining county-level Marketplace enrollment data for the 2015 through 2018 open enrollment periods showed a statistically significant relationship between insurance enrollment and airings of advertisements by state sponsors in particular (Shafer et al, 2020). Another study examining discontinuities in advertising between media markets also found relationships between advertising and enrollment, but these relationships differed based on sponsor type (state or federal government vs. private companies; Aizawa & Kim, 2020).…”