Effectiveness of Letters to Increase Health Insurance Enrollment

JAMA Health Forum


In this RCT, we found that a low-cost letter, targeting individuals who took the first steps toward enrolling in ACA marketplace coverage but stopped short of selecting a plan, caused statistically significant and meaningful increases in ACA health insurance enrollment. From 2017 to 2020, enrollment in the ACA marketplaces declined from 12.2 million to 11.4 million in part because of a reduction in marketing and advertising. As the Biden administration seeks to expand coverage, particularly among racial and ethnic minorities hard hit by the COVID-19 pandemic, this study provides evidence that low-cost outreach—especially messages informed by the behavioral sciences—could help increase ACA marketplace enrollment.

Media advisory: The full study is linked to this news release.

ACCESS THE STUDY HERE: https://jamanetwork.com/journals/jama-health-forum/fullarticle/10.1001/jamahealthforum.2022.0034?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=030422

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What The Study Did: This randomized clinical trial investigated if low-cost letters motivating individuals to finish enrolling in Affordable Care Act marketplace coverage could increase health insurance enrollment.

Authors: Andrew Feher, Ph.D., of Covered California in Sacramento, California, is the corresponding author.


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Yokum D, Hopkins DJ, Feher A, Safran E, Peck J. Effectiveness of Behaviorally Informed Letters on Health Insurance Marketplace Enrollment: A Randomized Clinical Trial. JAMA Health Forum. 2022;3(3):e220034. doi:10.1001/jamahealthforum.2022.0034

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