by Dylan Scott · September 5, 2017
The Trump administration is planning to cut money for Obamacare advertising by 90 percent. It certainly sounds like that move is likely to hurt next year’s enrollment.
The law’s supporters are worried and crying sabotage. HHS officials have countered that the money was being spent inefficiently, and they are still promising to uphold their duties under the law.
Luckily, some new research can help us cut through the noise.
Kentucky provides a great test case for what happens when Obamacare transfers from a supportive administration that goes all-in on enrollment to a hostile one that cuts back on outreach.
When Obamacare enrollment started in 2014, Kentucky was held up as a sterling example of what the law could be. Democratic Gov. Steve Beshear set up one of the best-working marketplaces in the country and the state pushed to sign up as many people as possible for Medicaid and private coverage.
By the end of 2015, as Beshear’s tenure came to a close, Kentucky had tied Arkansas for the biggest drop in the uninsured rate under Obamacare, from 20.4 percent to 7.5 percent in two years.
But that December, Beshear left office and a stalwart anti-Obamacare Republican, Matt Bevin, became governor. He abruptly cut off any state funding for Obamacare advertising, leading to four weeks of enrollment without any ad support.
That’s where a quartet of researchers associated with the Robert Wood Johnson Foundation and the Wesleyan Media Project come in. They took a look at the difference between strong outreach for the law and the bare minimum — an imperfect but still telling analogue to what Obamacare will experience nationwide this coming year.
Using advertising data from the Wesleyan Media Project and data from Kentucky’s marketplace, the researchers (who summarized their findings at the Incidental Economist) compared the first two years with robust advertising to the period without ads and found that there would have been:
450,000 fewer page views per week on the website for the state Obamacare marketplace without TV advertising;
20,000 fewer unique visitors per week to the website without TV advertising; and
no notable change in calls to the marketplace’s call center.
The researchers — University of North Carolina’s Paul Shafer, the Wesleyan Media Project’s Erika Franklin Fowler and Laura Baum, and the University of Minnesota’s Sarah Gollust — summarized their findings like this:
“Our analysis tells us that state-sponsored television advertising was a substantial driver of information-seeking behavior in Kentucky during open enrollment –– a critical step to getting consumers to shop for plans, understand their eligibility for premium tax credits or Medicaid, and enroll in coverage.”
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While correlation does not causation, it should be noted that Obamacare enrollment fell from 106,300 in 2015 (under Beshear) to 93,700 in 2016 (when Bevin took over partway through enrollment) to 81,200 in 2017 (the first full enrollment period under Bevin). Shafer told me they are working to quantify the impact on applications submitted and final enrollment.
The connection is strengthened when you account for other research that links increased Obamacare advertising with higher enrollment. We also saw Obamacare sign-ups tail off earlier this year after Trump cut off advertising in the last days of open enrollment.
This is a long way of saying we have empirical evidence to back up what you probably assumed to be true: Less advertising leads to less engagement and likely lower enrollment.
That’s bad news for the health of the marketplaces. Sick people are probably going to find a way to sign up for insurance no matter what. It’s the healthier people, whose enrollment is essential to keeping costs down for insurers, who are more the targets of Obamacare advertising.
As Tim Jost, a Washington and Lee University health law professor, told me last week before HHS announced the outreach funding cuts:
“The surest way to kill the exchanges is to keep them a secret.”
Chart of the Day
Fentanyl is driving the spike in drug overdose deaths. If you aren’t already, you’re gonna want to get up to speed on fentanyl, the synthetic opioid that is responsible for a bigger and bigger share of drug overdose fatalities.
While death from other prescription painkillers actually dropped slightly in 2016, overall deaths were still trending upward because of increased deaths from heroin and especially synthetic opioids, of which fentanyl is the most prominent.
More from Vox’s German Lopez here.
With research help from Caitlin Davis
Today’s top news
“Groups press lawmakers to stabilize ObamaCare markets”: “Nearly 100 consumer, patient and provider organizations are asking lawmakers to quickly pass a bipartisan bill to stabilize the ObamaCare insurance markets as the Senate Health Committee gears up for a series of hearings on the issue beginning Wednesday.” —Rachel Roubein, the Hill
“GOP ability to dismantle health law expires at month’s end”: “Senate Republicans will soon run out of time to rely on the barest of their majority to dismantle the Obama health law. The Senate parliamentarian has determined that rules governing the effort will expire when the fiscal year ends Sept. 30, according to independent Sen. Bernie Sanders of Vermont, the ranking member of the Senate Budget Committee.” —the Associated Press
“ACA allies plot their own enrollment push”: “The plan is still under wraps for now; an announcement could come as early as this week. But the approach sounds like it’ll be roughly in line with the role Enroll America had played during the first four open-enrollment periods, before closing its doors this past spring.” —Sam Baker, Axios
Analysis and longer reads
“Senate’s Obamacare fixes would build on heavy lifting by states”:“While Congress was busy bickering over repealing the health law, officials in red and blue states worked frantically to soothe anxious insurers, tamp down rate increases and insulate their markets from the ceaseless chaos in Washington. The result is an Obamacare system that’s still vulnerable, but far from the “disaster” President Donald Trump and his top health officials describe.” —Adam Cancryn, Politico
“How we can find common ground on health care”: “We should strengthen protections and put more power in the hands of patients, not move health care backward and put insurance companies back in charge. Families rejected the damaging approach taken in Trumpcare, and now it’s time for both parties to find common ground on solutions that actually help patients and families.” —Sen. Patty Murray, the Washington Post
“Is the price right? Solving healthcare’s transparency problem”: “The push to bring transparency to healthcare pricing and quality has been going on for years, but still the industry undoubtedly remains one of the nation’s most opaque. The scarcity of price and quality information is often blamed for the high cost of care.” —Shelby Livingston, Modern Healthcare