Effectiveness of Behaviorally Informed Letters on Health Insurance Marketplace Enrollment: A Randomized Clinical Trial

Importance Every year during the open enrollment period, hundreds of thousands of individuals across the Affordable Care Act marketplaces begin the enrollment process but fail to complete it, thereby resulting in coverage gaps or going uninsured. Objective To investigate if low-cost ($0.55 per perso...

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Bibliographic Details
Published in:JAMA health forum 2022-03, Vol.3 (3), p.e220034-e220034
Main Authors: Yokum, David, Hopkins, Daniel J., Feher, Andrew, Safran, Elana, Peck, Joshua
Format: Article
Language:English
Subjects:
Behavioral sciences
Clinical trials
Comments
Enrollments
Health insurance
Hispanic people
Insurance coverage
Medicaid
Online Only
Original Investigation
Patient Protection & Affordable Care Act 2010-US
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Summary:Importance Every year during the open enrollment period, hundreds of thousands of individuals across the Affordable Care Act marketplaces begin the enrollment process but fail to complete it, thereby resulting in coverage gaps or going uninsured. Objective To investigate if low-cost ($0.55 per person) letters can increase health insurance enrollment. Design, Setting, and Participants This intent-to-treat randomized clinical trial was conducted during the final 2 weeks of the 2015 open enrollment period among the 37 states on the HealthCare.gov platform. The trial targeted 744 510 individuals who started the enrollment process but had yet to complete it. Data were analyzed from January through August 2021. Interventions Study participants were randomized to either a no-letter control group or to 1 of 8 letter variants that drew on evidence from the behavioral sciences about what motivates individuals to take action. Main Outcomes and Measures The primary outcome was the health insurance enrollment rate at the end of the open enrollment period. Results Of the 744 510 individuals (mean [SD] age, 41.9 [19.6] years; 53.9% women), 136 122 (18.3%) were in the control group and 608 388 (81.7%) were in the treatment group. Most lived in Medicaid nonexpansion states (72.7%), and a plurality were between 30 and 50 years old (41.0%). For race and ethnicity, 3.0% self-identified as Asian, 14.0% as Black, 5.1% as Hispanic, 39.8% as non-Hispanic White, and 38.2% as other or unknown. By the end of the open enrollment period, 4.0% of the control group enrolled in health insurance coverage. Comparatively, the enrollment rate in the pooled treatment group was 4.3%, which demonstrated an increase of 0.3 percentage points (95% CI, 0.2-0.4 percentage points;P
ISSN:2689-0186
2689-0186
DOI:10.1001/jamahealthforum.2022.0034