Increasing Health Insurance Enrollment Among Uninsured Americans

NCT ID: NCT05010395

Last Updated: 2021-08-18

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

811795 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-01-15

Study Completion Date

2015-06-01

Brief Summary

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

Detailed Description

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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.

Conditions

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Health Behavior

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

OTHER

Blinding Strategy

NONE

Study Groups

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Control

Individuals in this arm did not receive a letter.

Group Type NO_INTERVENTION

No interventions assigned to this group

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.

Group Type EXPERIMENTAL

Letter intervention

Intervention Type BEHAVIORAL

Letter intervention

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").

Group Type EXPERIMENTAL

Letter intervention

Intervention Type BEHAVIORAL

Letter intervention

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.

Group Type EXPERIMENTAL

Letter intervention

Intervention Type BEHAVIORAL

Letter intervention

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

Group Type EXPERIMENTAL

Letter intervention

Intervention Type BEHAVIORAL

Letter intervention

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."

Group Type EXPERIMENTAL

Letter intervention

Intervention Type BEHAVIORAL

Letter intervention

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."

Group Type EXPERIMENTAL

Letter intervention

Intervention Type BEHAVIORAL

Letter intervention

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."

Group Type EXPERIMENTAL

Letter intervention

Intervention Type BEHAVIORAL

Letter intervention

Arm 8: Kitchen Sink

Individuals in this arm received a letter that includes all behavioral dynamics except for the pledge (due to space limitations).

Group Type EXPERIMENTAL

Letter intervention

Intervention Type BEHAVIORAL

Letter intervention

Interventions

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Letter intervention

Letter intervention

Intervention Type BEHAVIORAL

Eligibility Criteria

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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.
Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Office of Evaluation Sciences

FED

Sponsor Role lead

Responsible Party

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David Yokum

Director of The Policy Lab

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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David Yokum, PhD

Role: PRINCIPAL_INVESTIGATOR

Brown University

References

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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 Mar 4;3(3):e220034. doi: 10.1001/jamahealthforum.2022.0034. eCollection 2022 Mar.

Reference Type DERIVED
PMID: 35977283 (View on PubMed)

Other Identifiers

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02152015

Identifier Type: -

Identifier Source: org_study_id

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