Increasing Health Insurance Enrollment Among Uninsured Americans

August 10, 2021 updated by: David Yokum, Office of Evaluation Sciences
This randomized evaluation used behaviorally-informed letters to increase health insurance take-up on the Affordable Care Act (ACA) Marketplaces.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

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.

Study Type

Interventional

Enrollment (Actual)

811795

Phase

  • Not Applicable

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • ADULT
  • OLDER_ADULT
  • CHILD

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

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.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: OTHER
  • Allocation: RANDOMIZED
  • Interventional Model: PARALLEL
  • Masking: NONE

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
NO_INTERVENTION: Control
Individuals in this arm did not receive a letter.
EXPERIMENTAL: Arm 1: Basic Letter
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
Letter intervention
EXPERIMENTAL: Arm 2: Action
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
Letter intervention
EXPERIMENTAL: Arm 3: Action, Implementation
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
Letter intervention
EXPERIMENTAL: Arm 4: Action, Implementation, Picture
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
Letter intervention
EXPERIMENTAL: Arm 5: Norm
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
Letter intervention
EXPERIMENTAL: Arm 6: Norm, Pledge
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
Letter intervention
EXPERIMENTAL: Arm 7: Loss Aversion
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
Letter intervention
EXPERIMENTAL: Arm 8: Kitchen Sink
Individuals in this arm received a letter that includes all behavioral dynamics except for the pledge (due to space limitations).
Behavioral: Letter intervention
Letter intervention

What is the study measuring?

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.
Time Frame: Two weeks
Percent of individuals enrolling in an ACA plan during the observation period.
Two weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Office of Evaluation Sciences

Investigators

  • Principal Investigator: David Yokum, PhD, Brown University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (ACTUAL)

January 15, 2015

Primary Completion (ACTUAL)

February 15, 2015

Study Completion (ACTUAL)

June 1, 2015

Study Registration Dates

First Submitted

July 9, 2021

First Submitted That Met QC Criteria

August 10, 2021

First Posted (ACTUAL)

August 18, 2021

Study Record Updates

Last Update Posted (ACTUAL)

August 18, 2021

Last Update Submitted That Met QC Criteria

August 10, 2021

Last Verified

August 1, 2021

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • 02152015

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Plan Description

Deidentified replication data will be posted to OSF upon manuscript acceptance.

IPD Sharing Supporting Information Type

  • STUDY_PROTOCOL
  • ANALYTIC_CODE

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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