Reasons Why Individuals Remain Uninsured Under the Affordable Care Act: Experiences of Patients at a Student-Run Free Clinic in Michigan, a Medicaid Expansion State

Desmond, Brian S.; Laux, Molly A.; Levin, Carolyn; Huang, Jiaxin; Williams, Brent C.

doi:10.1007/s10900-015-0112-3

Cited by 9 publications

(3 citation statements)

References 4 publications

(8 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…To understand why eligible individuals remain uninsured, several studies have explored consumer experiences with the exchange Marketplaces and Medicaid expansion ( 16 , 23 , 24 , 26 , 29 , 30 , 40 , 41 , 74 , 89 ). Similar to the experiences in Massachusetts ( 20 , 66 ), common barriers to enrollment have included perceived cost of coverage ( 16 , 23 , 29 , 30 , 40 ), limited awareness about coverage expansions and eligibility ( 29 , 30 , 40 , 89 ), difficulty navigating the enrollment process ( 16 , 23 , 30 ), and language barriers ( 41 , 89 ); application assistance from navigators has helped to mitigate some of these barriers ( 89 ). Despite enrollment challenges, adults with new Marketplace or Medicaid coverage have reported high satisfaction with their insurance, doctors offered in network, ease of finding doctors, and affordability and access to care, comparable with reports from other insured adults ( 24 , 26 , 74 ).…”

Section: Aca Impacts On Coverage Of Low-income Populationsmentioning

confidence: 99%

The Affordable Care Act's Impacts on Access to Insurance and Health Care for Low-Income Populations

Kominski

Nonzee

Sorensen

2017

Annu. Rev. Public Health

136

View full text Add to dashboard Cite

The Patient Protection and Affordable Care Act (ACA) expands access to health insurance in the United States, and, to date, an estimated 20 million previously uninsured individuals have gained coverage. Understanding the law’s impact on coverage, access, utilization, and health outcomes, especially among low-income populations, is critical to informing ongoing debates about its effectiveness and implementation. Early findings indicate that there have been significant reductions in the rate of uninsurance among the poor and among those who live in Medicaid expansion states. In addition, the law has been associated with increased health care access, affordability, and use of preventive and outpatient services among low-income populations, though impacts on inpatient utilization and health outcomes have been less conclusive. Although these early findings are generally consistent with past coverage expansions, continued monitoring of these domains is essential to understand the long-term impact of the law for underserved populations.

show abstract

Section: Aca Impacts On Coverage Of Low-income Populationsmentioning

confidence: 99%

The Affordable Care Act's Impacts on Access to Insurance and Health Care for Low-Income Populations

Kominski

Nonzee

Sorensen

2017

Annu. Rev. Public Health

136

View full text Add to dashboard Cite

show abstract

“…Research suggests a number of potential barriers to take-up, including the complexity of choosing and applying for benefits, potential stigma asso-ciated with participation, lack of awareness of options, and a greater focus on avoiding present hassles than on mitigating future risks. 14,[24][25][26][27][28][29][30][31][32][33] These potential barriers suggest that targeted outreach that raises awareness and simplified enrollment processes might increase take-up. With the implementation of the ACA, a number of states have made efforts to increase enrollment rates among uninsured people who are eligible for Medicaid.…”

mentioning

confidence: 99%

Low-Cost Behavioral Nudges Increase Medicaid Take-Up Among Eligible Residents Of Oregon

et al. 2017

View full text Add to dashboard Cite

Efforts to reduce the ranks of the uninsured hinge on take-up of available programs and subsidies, but take-up of even free insurance is often less than complete. The evidence of the effectiveness of policies aiming to increase take-up is limited. We used a randomized controlled design to evaluate the impact of improved communication and behaviorally informed "nudges" designed to increase Medicaid take-up among eligible populations. Fielding randomized interventions in two different study populations in Oregon, we found that even very low-cost interventions substantially increased enrollment. Effects were larger in a population whose members had already expressed interest in obtaining coverage, but the effects were more persistent in low-income populations whose members were already enrolled in other state assistance programs but had not expressed interest in health insurance. The effects were similar across different demographic groups. Our results suggest that improving the design of enrollment processes and using low-cost mass-outreach efforts have the potential to substantially increase insurance coverage of vulnerable populations.

show abstract

“…This approach weighs the insurance premium price (net of subsidies) against the expected utility the individual consumer will get from such coverage. Accordingly, research on the decision to purchase health insurance has predominantly been based on traditional economics frameworks focused on concerns about cost and complexity, which the ACA targeted through penalties, subsidies, and standardized policies on the exchanges, with guaranteed benefits (Baicker et al, 2012; Desmond et al, 2016; Graves & Long, 2006; O'Donoghue & Somerville, 2018).…”

Section: Literature Reviewmentioning

confidence: 99%

Can moral framing drive insurance enrollment in the United States?

Epstein

Robertson

Yokum

et al. 2022

J Empirical Legal Studies

View full text Add to dashboard Cite

To encourage health insurance uptake, marketers and policymakers have focused on consumers' economic self‐interest, attempting to show that insurance is a good deal or to sweeten the deal, with subsidies or penalties. Still, some consumers see insurance as a bad deal, either because they rationally exploit private risk information (“adverse selection”), or irrationally misperceive the value due to cognitive biases (e.g., optimism). As a result, about 30 million Americans remain uninsured, including many who could afford it. At the same time, polling suggests that Americans view health insurance through a moral lens, seeking to protect those with pre‐existing conditions especially. In other markets, “green halo” and “noble edge” frames have been shown effective. As part of a broader research agenda on private law solutions to healthcare policy, we test whether moral framing could support insurance uptake. We report four phases of research. First, to understand current health insurance marketing in America, we collected the universe of advertisements from the state and federal exchanges and coded a 10% sample for themes of economic self‐interest versus three moral themes: helping others, helping community, or responsibility. In the 199 ads in which any theme appeared, 191 ads centered on economic self‐interest. Second, we enrolled 344 uninsured Americans in an online, vignette experiment where we offered various insurance plans. Over a baseline where 43.6% were willing to purchase insurance, we found that framing an economically identical plan around generosity yielded an 11.8% higher uptake. Third, we conducted five focus groups with 32 adults, including two groups in Spanish. We explored variations in the frames and probed for resistance, to prepare for the next phase of research. Fourth, using an online advertising platform (Google), we purchased 5.6 million advertising impressions in English and Spanish, targeting higher‐income Americans nationwide during the 2021 open‐enrollment period. Consumers saw advertisements from a control group (highlighting economic self‐interest, with real ads collected from the field) versus three experimental groups (helping others, helping community, or responsibility). We measured whether consumers clicked to “shop now” on the http://HealthCare.gov website (1.01% click‐through rate [CTR] in English and 1.38% CTR in Spanish at baseline). Helping community ads increased CTR over the control by 14.5% in English and by 33.7% in Spanish. Ads emphasizing responsibility increased CTR by 30.3% in English, though reduced CTR by 14.7% in Spanish. Helping others ads increased CTR by 9.8% in English but decreased CTR by 13.9% in Spanish. All of these results were significant at the 0.01 level and were robust to demographic controls and subgroup analyses, using individual and county‐level covariates. Although the optimal approach varies, the status quo self‐oriented message of economic rationality was not the top‐performing approach for either language group. Scaled up to real‐world ...

show abstract

Reasons Why Individuals Remain Uninsured Under the Affordable Care Act: Experiences of Patients at a Student-Run Free Clinic in Michigan, a Medicaid Expansion State

Cited by 9 publications

References 4 publications

The Affordable Care Act's Impacts on Access to Insurance and Health Care for Low-Income Populations

The Affordable Care Act's Impacts on Access to Insurance and Health Care for Low-Income Populations

Low-Cost Behavioral Nudges Increase Medicaid Take-Up Among Eligible Residents Of Oregon

Can moral framing drive insurance enrollment in the United States?

Contact Info

Product

Resources

About