Television Advertising, News and the Uninsured: Market Level Evidence from the First Open Enrollment Period of Health Insurance Marketplaces

The Affordable Care Act (ACA) established marketplaces where consumers could directly purchase health insurance from the insurance carriers. While typically, the health insurance markets in the U.S. are characterized by the presence of imperfect information and complex products, the new marketplaces addressed some of these concerns by simplifying the insurance products and standardizing them across metal levels (bronze, silver, gold, platinum). The introduction of these marketplaces were accompanied by massive media campaigns from Federal, State, and non-profit organizations, as well as the insurance companies themselves, informing consumers about the existence of these new marketplaces and the different health plans they could find there. An estimated $3.153 billion was spent on local and national TV commercials throughout the open enrollment period that ended in March 2014. It is well-established that the mass media influence the public’s attitudes, opinions, and behaviors, so these media messages are expected to shape public perceptions of the ACA, including knowledge of the health insurance options available to the millions of Americans who would gain access to health insurance under the law.

This paper documents, for the first time, the relationship between local televised media and health insurance enrollment in order to provide new evidence on the effectiveness of media strategies related to the ACA. Using Kantar Media/CMAG data (available to us through the Wesleyan Media Project) from the first open enrollment period, October 2013 through March 2014, we identify all health insurance commercials that aired on local and national TV. This unique data source provided details on the stations that aired the commercials, when they aired, the sponsor of each commercial, its estimated cost, and which Nielsen Designated Market Area (DMA) the commercial aired in. These DMA codes allowed us to combine Kantar’s records to county level insurance coverage type data from the American Community Survey’s 1 –year estimates in 2013 and 2014, as well as exchange enrollment-size data from ASPE on the number of plans that were purchased in Federal exchanges during the first open enrollment period (these were rolled-up from 5-digit Zip code to county). In addition, we linked our data to county-level socio-economic characteristics and state ratings areas data on the silver plans (e.g., their premiums, their issuers) that were offered in each county during the first open-enrollment period.

We find that counties with higher volume of exposure to local ads had higher rates of enrollment in the individual market. In forthcoming analyses, we further distinguish this relationship by volume and tone of media, as well as by type of sponsor (e.g., Federal, insurance company). In addition, we explore whether the size of uninsured and individual market enrollment at the county level were associated with the intensity of advertising competition across insurers.