Increasing Health Insurance Enrollment Among Uninsured Americans

Not Applicable

Completed

• Conditions: Health Behavior
• Interventions: Behavioral: Letter intervention

• Registration Number: NCT05010395
• Lead Sponsor: Office of Evaluation Sciences

Brief Summary

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

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 Timeline

• Study Start: 2015-01-15
• Primary Completion: 2015-02-15
• Study Completion: 2015-06-01
• Study First Submitted: 2021-07-09
• Status Verified: 2021-08
• Study First Submitted QC: 2021-08-10
• Last Update Submitted: 2021-08-10
• Study First Posted: 2021-08-18
• Last Update Posted: 2021-08-18

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 811795

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 & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Arm 1: Basic Letter	Letter intervention	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.
Arm 7: Loss Aversion	Letter intervention	Individuals in this arm received a letter that warned "You risk paying a fee of $325 or 2% of your income-whichever is higher."
Arm 2: Action	Letter intervention	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").
Arm 8: Kitchen Sink	Letter intervention	Individuals in this arm received a letter that includes all behavioral dynamics except for the pledge (due to space limitations).
Arm 6: Norm, Pledge	Letter intervention	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."
Arm 3: Action, Implementation	Letter intervention	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.
Arm 4: Action, Implementation, Picture	Letter intervention	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
Arm 5: Norm	Letter intervention	Individuals in this arm received a letter that included the following social norm sentence: "Americans are enrolling but you haven't joined them."

Primary Outcome Measures

Name	Time	Method
Percent of individuals enrolling in an ACA plan by the end of the Open Enrollment period.	Two weeks	Percent of individuals enrolling in an ACA plan during the observation period.