Cuts to Navigator Funding Were Not Associated With Changes to Private Sector Advertising in the ACA Marketplaces
25 Pages Posted: 11 Feb 2022 Last revised: 25 Feb 2022
Date Written: December 9, 2021
Abstract
Despite increased availability of subsidized coverage in the Affordable Care Act (ACA) marketplace, many consumers remain unenrolled because of information barriers. Whether outreach to consumers to address these barriers should be conducted by the private sector or public sector is a topic of active policy debate. We studied the impact of cuts to a major public sector program conducting such outreach - the ACA navigator program - on private sector outreach. The analysis examined the effect of the 80% cut in program funding for federally-facilitated marketplace states under the Trump administration for the 2018 open enrollment period as a natural experiment, exploiting county-level differences in the navigator program prior to funding cuts in a difference-in-difference analysis. Health insurance advertising was measured using data from Kantar/CMAG in collaboration with the Wesleyan Media Project for the 2015 through 2019 open enrollment periods.
The results did not show any significant change in private sector advertising in response to cuts to the public sector navigator program, including total number of advertisements or advertisements specific to the marketplace or other non-Medicaid, non-Medicare plans. In our main specification, private sector advertisements targeting the marketplace or other non-Medicare, non-Medicaid health insurance sources decreased by 1 advertisement annually in response to the funding cuts, a 0% change compared to the 1,655 advertisements aired at baseline. Placebo tests showed no change in airings by private sponsors related to Medicare in response to navigator program cuts, as expected, and findings remained similar under alternate specifications. These data can inform current policy debates about the extent to which private sector efforts substitute for public sector outreach efforts to assist marketplace consumers.
Keywords: Affordable Care Act, navigators, health insurance, health insurance literacy, advertising, administrative burden
JEL Classification: I11, I13, I18
Suggested Citation: Suggested Citation