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The Determinants of Health Insurance Take-up and Plan Choice in the United States
Last registered on June 29, 2017

Pre-Trial

Trial Information
General Information
Title
The Determinants of Health Insurance Take-up and Plan Choice in the United States
RCT ID
AEARCTR-0002115
Initial registration date
June 29, 2017
Last updated
June 29, 2017 2:11 PM EDT
Location(s)
Primary Investigator
Affiliation
UCLA
Other Primary Investigator(s)
Additional Trial Information
Status
Completed
Start date
2015-09-14
End date
2016-01-31
Secondary IDs
Abstract
In response to the Affordable Care Act (ACA) passing legislation to improve the affordability and efficiency of health care delivery in the U.S., the researcher aims to focus on two choices that individuals tend to make: 1) decision to take-up coverage and 2) choice of health plan. The challenges that the researcher analyze are individuals' propensities to 1) choose less generous but more expensive plans, 2) not transparent provider networks. The researcher proposes two studies in particular: 1) Plan Choice Study that identifies key factors affecting plan choice in Covered California (California's health insurance marketplace) by providing easily comparable price and provider network information on plane choice and implications in regard to consumer welfare, market price elasticity and risk selection and 2) take-up study, which identifies key determinants of take-up of coverage in the individual health insurance exchange by estimating the impact of providing information on subsidies, political narrative and potential penalties.
External Link(s)
Registration Citation
Citation
Yin, Wesley. 2017. "The Determinants of Health Insurance Take-up and Plan Choice in the United States." AEA RCT Registry. June 29. https://doi.org/10.1257/rct.2115-1.0.
Former Citation
Yin, Wesley. 2017. "The Determinants of Health Insurance Take-up and Plan Choice in the United States." AEA RCT Registry. June 29. http://www.socialscienceregistry.org/trials/2115/history/19076.
Experimental Details
Interventions
Intervention(s)
he researcher proposes two studies in particular: 1) Plan Choice Study that identifies key factors affecting plan choice in Covered California (California's health insurance marketplace) by providing easily comparable price and provider network information on plane choice and implications in regard to consumer welfare, market price elasticity and risk selection and 2) take-up study, which identifies key determinants of take-up of coverage in the individual health insurance exchange by estimating the impact of providing information on subsidies, political narrative and potential penalties.

The study will utilize administrative data from Covered California, quarterly provide network data and plan premiums for every plan sold in 2015 and 2016 by country. The researcher also plans to conduct a supplemental email-based survey to ask take-up study participants about penalty and subsidy awareness.
Intervention Start Date
2015-10-12
Intervention End Date
2016-01-31
Primary Outcomes
Primary Outcomes (end points)
health insurance plan choice, namely switching behavior to plans that are better for them in possible risk-based selection (i.e. purchase of the enhanced silver plan); health insurance take-up rate
Primary Outcomes (explanation)
Secondary Outcomes
Secondary Outcomes (end points)
Secondary Outcomes (explanation)
Experimental Design
Experimental Design
Plan Choice Study: This study focuses on renewal choice. Participants are randomly drawn from 1.5 million Covered California enrollees at the start of 2016 and are assigned to one of five arms: 1) control (receives standard marketing of one letter), 2) Standard 2x (receives two standard marketing letters with the second one sent out closer to the end of the renewal window, 3) Delta Premium (receives two letters from Covered California, containing standard information plus a table reporting estimated changes in net-of-subsidy premiums by available plan, 4) Delta Premium + Network (receives two letters from Covered California, containing the same table as the Delta Price treatment plus two columns that discuss provider quality and 5) Level Premium + Network (receives two letters from CC, containing the same table as in the Delta Price + Network, except that premiums are reported in levels.

Take-Up Study: Take-up study participants are randomly drawn from the funnel and disenrolled Medi-Cal populations. They are randomized into one of four arms: 1) control (no marketing), 2) subsidy treatment (receives two letters that remind consumers of the value of insurance, enrollment deadline and estimated subsidy, 3) subsidy + penalty treatment (receives the same two waves of email and mail) and pro-private treatment (the subsidy + penalty treatment except that the narrative of the message highlights the private sector nature of the marketplace, consumer choice of private plans and the benefits of competition on lowering costs.
Experimental Design Details
Randomization Method
Not specified
Randomization Unit
Individual
Was the treatment clustered?
No
Experiment Characteristics
Sample size: planned number of clusters
n/a
Sample size: planned number of observations
45,000 individuals
Sample size (or number of clusters) by treatment arms
100,000 in control and 15,000 per treatment arm
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
IRB
INSTITUTIONAL REVIEW BOARDS (IRBs)
IRB Name
North General IRB, UCLA
IRB Approval Date
2015-10-13
IRB Approval Number
15-001549
Post-Trial
Post Trial Information
Study Withdrawal
Intervention
Is the intervention completed?
Yes
Intervention Completion Date
January 31, 2016, 12:00 AM +00:00
Is data collection complete?
Yes
Data Collection Completion Date
January 31, 2016, 12:00 AM +00:00
Final Sample Size: Number of Clusters (Unit of Randomization)
122873
Was attrition correlated with treatment status?
No
Final Sample Size: Total Number of Observations
122873
Final Sample Size (or Number of Clusters) by Treatment Arms
control: 25152; reminder only arm: 24374; reminder+subsidy/penalty info arm: 24420; reminder+plan choice info arm: 24433; reminder+plan choice/quality rating arm: 24494
Data Publication
Data Publication
Is public data available?
No
Program Files
Program Files
Reports, Papers & Other Materials
Relevant Paper(s)
REPORTS & OTHER MATERIALS