ACA Health Insurance Ads Targeted Younger, Healthier Consumers From 2013 to 2016

Analysis of television ads also found a sharp decline in mentions of “Obamacare” or “Affordable Care Act” over three enrollment periods

The themes in television advertisements for health insurance plans have shifted over time, possibly reflecting the shrinking pool of health plans offered through the Affordable Care Act (ACA) as well as rising plan premiums, according to a study led by researchers at the Johns Hopkins Bloomberg School of Public Health.

In the study, published online in the Journal of Health Politics, Policy and Law, the researchers analyzed the volume and content of media messages included in insurance advertisements that were aired over a million times in the U.S. from late 2013 through spring 2016. One key finding: explicit mentions of Obamacare or ACA declined sharply.

“These marketplace health plans that became available following the passage of the health care law under President Obama were heavily government-subsidized and contributed to substantial declines in uninsurance rates in the U.S.,” says study lead author Colleen L. Barry, PhD, the Fred and Julie Soper Professor and Chair of the Department of Health Policy and Management at the Bloomberg School. “Yet, in the absence of an explicit mention of the law in ads, newly insured individuals may not have appreciated the connection between the law and the health benefits they were receiving.”

The ACA, often called Obamacare, is a major health policy initiative enacted in 2010 that led to the introduction of new marketplace plans designed to make it easier for consumers to access health care through the individual and small group insurance market starting in 2014. Television ads for ACA plans, which are sponsored mostly by private insurers and through state and federal enrollment efforts, first began marketing to consumers in late fall 2013.

For the study, through the Wesleyan Media Project at Wesleyan University, the researchers obtained a database of video files for all of the health insurance-related television ads that aired in U.S. media markets during the first three ACA open-enrollment periods in 2013-14, 2014-15 and 2015-16. The study authors took a random sample of the ads, ending up with 875 unique advertisements that represented 1,074,653 airings in all 50 states.

The researchers viewed and coded each ad for characteristics including: the type of people featured in the ads, the activities they were engaged in, the references to ACA or Obamacare, and the messages about various benefits of the health plans available.

One finding, not unexpected, was that overtime the ads increasingly included content aimed at selling policies to younger, healthier people, whose enrollment in large numbers is essential to the long-term plan solvency. Relatively few airings focused on elderly or disabled people, smokers or people receiving medical care in a hospital or clinic—the kinds of people who tend to generate more costly health insurance claims.

“What we saw over the three enrollment periods is that as costs became a greater concern for insurers, advertising increasingly targeted so-called ‘young invincibles’—younger and healthy individuals who may be tempted to forego insurance,” Barry says.

The researchers also noted a shift, over the three open enrollment periods, toward messages emphasizing the availability of financial assistance with premiums, and away from messages emphasizing plan choice. The trend corresponded to sharp increases in average ACA plan premiums and reductions in plan choice as some major insurers pulled out of ACA marketplaces.

Even more dramatic, Barry and her colleagues found, was the trend towards ads that did not mention ACA. “By the third enrollment period in 2016 only about 10 percent of the airings by non-government sponsors specifically referred to ACA or Obamacare,” Barry says. “So there was a real movement by those sponsors to avoid connecting their products with the law itself.”

The researchers suggest that this trend may relate to a low level of public understanding of ACA, which advertisers may have increasingly recognized and accommodated—and which in turn may have worsened the public’s understanding.

“Public opinion data have shown consistently that many Americans do not understand the key components of the law or believe they have benefited from it,” Barry says.

The researchers worry that not making clear the connection between an individual’s health care and a major government program is problematic—not just for ACA but for government-sponsored programs generally. They cite the political scientist Suzanne Mettler, who has argued that public support for governmental programs will remain low, and indeed trust in government will remain low, insofar as citizens fail to see the benefits they receive from the government.

“If we want the public to understand the value of major government initiatives like ACA, then it is important to highlight these connections between health care benefits and government initiatives more explicitly,” Barry says.

“Assessing the Content of Television Health Insurance Advertising during Three Open Enrollment Periods of the ACA” was written by Colleen L. Barry, Sachini Bandara, Kimberly Arnold, Jessie Pintor, Laura Baum, Jeff Niederdeppe, Pinar Karaca-Mandic, Erika Franklin Fowler and Sarah Gollust.

Funding was provided by the Robert Wood Johnson Foundation.

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Media contacts for the Johns Hopkins Bloomberg School of Public Health: Barbara Benham at 410-614-6029 or bbenham1@jhu.edu and Robin Scullin at 410-955-7619 or rsculli1@jhu.edu.