States’ ACA Ads Are Declining, But Vital.
Three years after Donald Trump campaigned on the promise to eliminate the Affordable Care Act, the program’s fate is still uncertain, with the administration now officially siding with plaintiffs in a Supreme Court case to strike down the entire ACA.
But an overlooked yet significant threat to the ACA is a decline in government–sponsored advertising for enrollment through the Marketplace, as the collection of state- and federally-run health insurance exchanges is known, according to a new study led by a School of Public Health researcher.
The first-of-its-kind study, published in RSF: The Russell Sage Foundation Journal of the Social Sciences, finds that the number of state-sponsored TV ads for health insurance aired in a county is associated with that county’s enrollment gains (evidence was inconclusive for the federally-sponsored ads for HealthCare.gov, which the Trump administration eliminated beginning with the 2018 enrollment period). Government-sponsored advertising for the Marketplace has been dwindling since its launch in late 2013.
“This has big implications for open enrollment this year,” says study lead author Paul Shafer, assistant professor of health law, policy & management. “We will likely still be struggling through this pandemic recession, making many more Americans eligible for Medicaid or financial assistance in the Marketplace who may not have been enrolled before, but with little to no advertising by state and federal governments to inform the public and encourage them to get covered if these trends continue.”
Shafer and colleagues used county-level data on TV advertising and Marketplace enrollment from the 2015-2018 open enrollment periods for the 34 states that used HealthCare.gov (rather than running their own exchanges). They included state- and federally-sponsored ads for the Marketplace and other public programs such as Medicaid and Medicare, ads from private insurers and insurance agencies, and pro-ACA/Democrat and anti-ACA/Republican health care–related political ads.
Previous research has suggested that ads related to health insurance have a “spillover effect,” such as ads for private insurance driving increased Marketplace enrollment. In this study, the researchers did find this to be the case, but the health insurance ads aired by state governments had the strongest association with ACA Marketplace enrollment.
This is worrying, Shafer says, because the study also found that government-sponsored insurance ads have been steadily declining for years before the Trump administration eliminated federal ads for Healthcare.gov. By the 2018 enrollment period, government ads for insurance—including the Marketplace, Medicaid, and Medicare—accounted for just 2 percent of all health insurance TV ads.
As the economic damage wrought by COVID continues, and “as uncertainty swirls about the future of the ACA because of the dual threats of a looming Supreme Court decision and the upcoming Presidential election,” Shafer says, “the need for clear and trustworthy messaging about the Marketplace again becomes critically important heading into 2021.”
The study’s senior author is Sarah E. Gollust of the University of Minnesota School of Public Health, and the other co-authors are: David M. Anderson of Duke University; Seciah M. Aquino of the California Immigrant Policy Center; and Laura M. Baum and Erika Franklin Fowler of the Wesleyan Media Project.