Increasing Health Insurance Enrollment Among Uninsured Americans

Study Overview
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Brief Summary
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This randomized evaluation used behaviorally-informed letters to increase health insurance take-up on the Affordable Care Act (ACA) Marketplaces.

Detailed Description
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During Open Enrollment Periods for the ACA Marketplaces, qualifying individuals can purchase health insurance plans through the Federal Health Insurance Marketplace (FHIM). As of early February 2015, many people had visited HealthCare.gov and started an online account, but not yet selected a plan. The Department of Health and Human Services (HHS), in collaboration with the Office of Evaluation Sciences (OES), developed and sent letters to assist these individuals with completing their enrollment before the deadline. To evaluate the effect of the letters, the team used a randomized controlled trial.

Official Title
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Increasing Health Insurance Enrollment Among Uninsured Americans

Conditions
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Health Behavior

Intervention / Treatment
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* Behavioral: Letter intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Those with an English language preference; those who had not enrolled in an ACA plan as of early February 2015 Exclusion Criteria: Those with a Spanish language preference This intervention was a program evaluation and did not go through Human Subjects Protection Review.
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Control<br>Individuals in this arm did not receive a letter. | |
| Experimental: Arm 1: Basic Letter<br>Individuals received a letter with information about the benefits of enrolling, the February 15th sign-up deadline, the HealthCare.gov website, and the call center phone number. | Behavioral: Letter intervention<br>* Letter intervention<br>|
| Experimental: Arm 2: Action<br>Individuals in this arm received a letter that emphasized only minimal marginal effort is required; and used adjectives and verbs connoting action (e.g., almost done, quick, act now, and fast). | Behavioral: Letter intervention<br>* Letter intervention<br>|
| Experimental: Arm 3: Action, Implementation<br>Individuals in this arm received a letter similar to Arm 2, but with the addition of a calendar that draws attention to the February 15th deadline; and provided fill-in blanks in which the recipient can write the planned month, day, and time when they intend to enroll. | Behavioral: Letter intervention<br>* Letter intervention<br>|
| Experimental: Arm 4: Action, Implementation, Picture<br>Individuals in this arm received a letter similar to Arms 2 and 3, but with the addition of an image of then HealthCare.gov Chief Executive Officer Kevin Counihan | Behavioral: Letter intervention<br>* Letter intervention<br>|
| Experimental: Arm 5: Norm<br>Individuals in this arm received a letter that included the following social norm sentence: Americans are enrolling but you haven't joined them. | Behavioral: Letter intervention<br>* Letter intervention<br>|
| Experimental: Arm 6: Norm, Pledge<br>Individuals in this arm received a letter that included a statement, to be checked in agreement, that I pledge to Get Covered at Healthcare.gov. | Behavioral: Letter intervention<br>* Letter intervention<br>|
| Experimental: Arm 7: Loss Aversion<br>Individuals in this arm received a letter that warned You risk paying a fee of $325 or 2% of your income-whichever is higher. | Behavioral: Letter intervention<br>* Letter intervention<br>|
| Experimental: Arm 8: Kitchen Sink<br>Individuals in this arm received a letter that includes all behavioral dynamics except for the pledge (due to space limitations). | Behavioral: Letter intervention<br>* Letter intervention<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percent of individuals enrolling in an ACA plan by the end of the Open Enrollment period. | Percent of individuals enrolling in an ACA plan during the observation period. | Two weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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health insurance enrollment