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From Health Affairs:

Repeated TV Ads Increased Signups During The ACA’s First Enrollment Period

Bethesda, MD—In the fall of 2013 television viewers in many US media markets saw numerous ads about the new Affordable Care Act (ACA) Marketplaces. The ads informed consumers about the insurance products and how to enroll. A new study, released by Health Affairs as a Web First, looked at county-level data on uninsurance and Medicaid enrollment rates for adults younger than age sixty-five in 2013 and 2014 and found a strong and stable association between the volume of insurance advertising and health insurance gains in counties. For the 629 counties included in the study, the average uninsurance rate fell by 2.9 percentage points from 2013 to 2014, and the decline was larger for counties with larger ad volume. The average media market included in the study ran 3,206 ads during the enrollment period. The authors estimate that for every additional 1,000 insurance ads, there was an average decline in uninsurance of 0.1 percentage point. This is the first study to link insurance coverage with the ACA-related marketing efforts undertaken by federal and state government as well as the efforts of private insurance companies and nonprofit agencies.

The Volume Of TV Advertisements During The ACA’s First Enrollment Period Was Associated With Increased Insurance Coverage

By Pinar Karaca-Mandic, Andrew Wilcock, Laura Baum, Colleen L. Barry, Erika Franklin Fowler,
Jeff Niederdeppe, and Sarah E. Gollust

Karaca-Mandic, Wilcock, and Gollust are affiliated with the University of Minnesota; Baum and Fowler are at Wesleyan University; Barry is affiliated with the Johns Hopkins University; and Niederdeppe with Cornell University.

This study, which was supported by the Robert Wood Johnson Foundation, will also appear in Health Affairs’ April issue. 

To obtain their study data, the authors extracted county-level data on uninsurance and Medicaid enrollment rates for Americans younger than age sixty-five from the Census Bureau’s American Community Survey one-year estimates in 2013 and 2014; they obtained television advertisement volume from the Kantar Media/Campaign Media Analysis Group through the Wesleyan Media Project. State-sponsored ads had the strongest relationship with declines in uninsurance. Furthermore, state-sponsored ads were also associated with increases in Medicaid enrollment. The authors found that the volume of advertising during that time varied, with more television ads aired in the Southwest and fewer in the Upper North Central region. (See exhibit below.)

“This study demonstrates that consumers are responsive to persuasive health communication messages about health insurance, but the type of advertisement might matter,” the authors concluded. “These results have implications beyond the initial implementation period of the ACA, since any new health insurance system, as currently being debated by Congress, will also rely on marketing to attract new consumers.”

About Health Affairs

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print and online, with frequent Web First studies and health policy briefs published at The full text of each Health Affairs Web First paper is available free of charge to all website visitors for a one-week period following posting, it then switches to pay-per-view for nonsubscribers. Web First papers are supported in part by a grant from The Commonwealth Fund. You can also find the journal on Facebook and Twitter. Read daily perspectives on Health Affairs Blog. Download our podcasts, including monthly Narrative Matters essays, on iTunes. Tap into Health Affairs content with the iPad app.