Increasing Health Insurance Enrollment Among Uninsured Americans
1 other identifier
interventional
811,795
0 countries
N/A
Brief Summary
This randomized evaluation used behaviorally-informed letters to increase health insurance take-up on the Affordable Care Act (ACA) Marketplaces.
Trial Health
Trial Health Score
Automated assessment based on enrollment pace, timeline, and geographic reach
participants targeted
Target at P75+ for not_applicable
Started Jan 2015
Shorter than P25 for not_applicable
Health score is calculated from publicly available data and should be used for screening purposes only.
Trial Relationships
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Study Timeline
Key milestones and dates
Study Start
First participant enrolled
January 15, 2015
CompletedPrimary Completion
Last participant's last visit for primary outcome
February 15, 2015
CompletedStudy Completion
Last participant's last visit for all outcomes
June 1, 2015
CompletedFirst Submitted
Initial submission to the registry
July 9, 2021
CompletedFirst Posted
Study publicly available on registry
August 18, 2021
CompletedAugust 18, 2021
August 1, 2021
1 month
July 9, 2021
August 10, 2021
Conditions
Keywords
Outcome Measures
Primary Outcomes (1)
Percent of individuals enrolling in an ACA plan by the end of the Open Enrollment period.
Percent of individuals enrolling in an ACA plan during the observation period.
Two weeks
Study Arms (9)
Control
NO INTERVENTIONIndividuals in this arm did not receive a letter.
Arm 1: Basic Letter
EXPERIMENTALIndividuals 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 2: Action
EXPERIMENTALIndividuals 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 3: Action, Implementation
EXPERIMENTALIndividuals 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
EXPERIMENTALIndividuals 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
EXPERIMENTALIndividuals in this arm received a letter that included the following social norm sentence: "Americans are enrolling but you haven't joined them."
Arm 6: Norm, Pledge
EXPERIMENTALIndividuals 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 7: Loss Aversion
EXPERIMENTALIndividuals in this arm received a letter that warned "You risk paying a fee of $325 or 2% of your income-whichever is higher."
Arm 8: Kitchen Sink
EXPERIMENTALIndividuals in this arm received a letter that includes all behavioral dynamics except for the pledge (due to space limitations).
Interventions
Letter intervention
Eligibility Criteria
You may qualify if:
- Those with an English language preference; those who had not enrolled in an ACA plan as of early February 2015
You may not qualify if:
- Those with a Spanish language preference
- This intervention was a program evaluation and did not go through Human Subjects Protection Review.
Contact the study team to confirm eligibility.
Sponsors & Collaborators
Related Publications (1)
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 Mar 4;3(3):e220034. doi: 10.1001/jamahealthforum.2022.0034. eCollection 2022 Mar.
PMID: 35977283DERIVED
MeSH Terms
Conditions
Condition Hierarchy (Ancestors)
Study Officials
- PRINCIPAL INVESTIGATOR
David Yokum, PhD
Brown University
Study Design
- Study Type
- interventional
- Phase
- not applicable
- Allocation
- RANDOMIZED
- Masking
- NONE
- Purpose
- OTHER
- Intervention Model
- PARALLEL
- Sponsor Type
- FED
- Responsible Party
- PRINCIPAL INVESTIGATOR
- PI Title
- Director of The Policy Lab
Study Record Dates
First Submitted
July 9, 2021
First Posted
August 18, 2021
Study Start
January 15, 2015
Primary Completion
February 15, 2015
Study Completion
June 1, 2015
Last Updated
August 18, 2021
Record last verified: 2021-08
Data Sharing
- IPD Sharing
- Will share
- Shared Documents
- STUDY PROTOCOL, ANALYTIC CODE
Deidentified replication data will be posted to OSF upon manuscript acceptance.