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Wednesday, September 6, 2017

Trump administration says Obamacare ads are no longer necessary, but research in Kentucky says otherwise

As the Trump administration works toward cutting 90 percent of the Obamacare advertising budget, research in Kentucky shows that "less advertising leads to less engagement and likely lower enrollment," Dylan Scott reports for Vox.

The Trump administration said last week that it is is planning to cut the Patient Protection and Affordable Care Act's advertising budget from $100 million to $10 million for the 2018 enrollment season.

Advocates of the law are concerned that the cut, plus a 41 percent cut for the in-person assistance program, will reduce outreach efforts that are critical to enrollment, especially during an enrollment period fraught with uncertainty. Some claimed the cuts are part of an effort to sabotage the program.

U.S. Department of Health and Human Services officials say advertising isn't necessary because most people already know about Obamacare and the money isn't being spent efficiently. HHS officials told reporters in August that they haven't done any "specific study" to prove that, and research argues against the claim.

A Commonwealth Fund study found that 38 percent of Americans who remain uninsured are unaware of the health law's marketplaces. Another study, published in Health Affairs, found increased ACA advertising was associated with increased insurance coverage during the first enrollment period and more recent research, using Kentucky data and summarized on The Incidental Economist, found similar results.

The Kentucky research, conducted by researchers associated with the Robert Wood Johnson Foundation and the Wesleyan Media Project, examined what happened when Kentucky shifted from a supportive Obamacare administration to a hostile one that cut back on outreach.

Under then-Gov. Steve Beshear, a Democrat who embraced Obamacare, Kentucky's uninsured rate dropped from 20.4 percent to 7.5 percent in two years. But when Republican Gov. Matt Bevin took over, "He abruptly cut off the state funding for Obamacare advertising, leading to four weeks of enrollment without any ad support," Scott notes.

Using advertising data from the Wesleyan Media Project and Kynect, the state's now-closed marketplace, researchers compared the first two years of Obamacare, which had robust advertising, to the four weeks without ads.

They found that without TV commercials there were 450,000 fewer page views per week on the Kynect website; 20,000 fewer unique visitors per week to the website; and no notable changes in calls to the marketplace's call center.

"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," the researchers wrote.

Of note, Obamacare enrollment fell from 106,300 in 2015, under Beshear, to 93,700 in 2016, when Bevin took over during the enrollment period, to 81,200 in 2017, the first full enrollment period under Bevin. Scott adds that Obamacare sign-ups also "tailed off" earlier this year when the Trump administration cut off advertising during the last days of open enrollment.

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