The Impact of Repeated Reminders on Receipt of Government Benefits: Experimental Evidence from Affordable Care Act Health Insurance Subsidies

Last registered on February 03, 2022
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Pre-Trial

Trial Information

General Information

Title
The Impact of Repeated Reminders on Receipt of Government Benefits: Experimental Evidence from Affordable Care Act Health Insurance Subsidies
RCT ID
AEARCTR-0008926
Initial registration date
February 02, 2022

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
February 03, 2022, 5:45 PM EST

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Locations

Country
United States of America
Region
California

Primary Investigator

Name
Andrew Feher
Affiliation
Covered California
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Other Primary Investigator(s)

PI Name
Rebecca Myerson
PI Affiliation
University of Wisconsin - Madison
Contact Investigator

Additional Trial Information

Status
Completed
Start date
2020-08-28
End date
2021-04-01
Keywords
Behavior, Health
Additional Keywords
randomized controlled trial; Affordable Care Act; health insurance; nudge
JEL code(s)
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
There is growing evidence that compliance costs affect take-up of government benefits. In the Affordable Care Act (ACA) health insurance marketplaces, households cannot receive health insurance premium subsidies without periodically updating their application information, a process known as consent for income verification. Each year, thousands of households fail to update their application and experience large premium increases due to the loss of subsidies. The goal of this project was to identify the effect of low-cost nudges - email reminders – on compliance with the application update requirement to remain eligible for premium subsidies.
External Link(s)

Registration Citation

Citation
Feher, Andrew and Rebecca Myerson. 2022. "The Impact of Repeated Reminders on Receipt of Government Benefits: Experimental Evidence from Affordable Care Act Health Insurance Subsidies." AEA RCT Registry. February 03. https://doi.org/10.1257/rct.8926-1.0
Sponsors & Partners
Experimental Details

Interventions

Intervention(s)
Households whose consent for verification was expiring at the end of 2020 were randomly assigned to one of three arms: (1) a 1-email arm, (2) a 2-email arm and (3) a 3-email arm.

Emails were sent on September 2, September 8, and September 15, and the second and third messages were repeats of the first. The subject line of the messages was: “Renewal is Coming: Have you Updated your Consent?” Households assigned to receive more than one email were not sent a second or third reminder if they updated their consent after the initial outreach. The messages provided a call-to-action date of September 30 and highlighted the implications of failing to update consent, namely, that the household would lose eligibility for financial help for 2021. In addition, the messages offered consumers multiple options for updating their consent and included a short YouTube tutorial with instructions for updating consent through their online account.
Intervention Start Date
2020-09-01
Intervention End Date
2020-09-15

Primary Outcomes

Primary Outcomes (end points)
The primary outcomes were (1) indicators for whether the household updated consent for income verification by the end of September 2020 and by the end of January 2021, (2) an indicator for whether the household was receiving subsidies in January 2021 and (3) the dollar amount of monthly subsidies received.
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
Our secondary outcomes include, (1) number of emails opened, (2) email open rate, (3) unsubscribe rate, (4) number of calls to the agency's call center and (5) continuation of coverage as measured by whether the household was still enrolled in coverage at the end of January 2021 and at the end of March 2021.
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
This study used a parallel 3-arm design with households randomly assigned to receive 1, 2, or 3 email reminders in September 2020.

The study population for the experiment included 22,817 currently enrolled households that had applied for subsidized Covered California coverage in 2021 but whose consent for income verification would expire at the end of 2020.
Experimental Design Details
Randomization Method
We used Stata 15 to conduct the randomization.
Randomization Unit
The unit of randomization was the household.
Was the treatment clustered?
No

Experiment Characteristics

Sample size: planned number of clusters
Not applicable.
Sample size: planned number of observations
22,817 households
Sample size (or number of clusters) by treatment arms
22,817 households
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Supporting Documents and Materials
IRB

Institutional Review Boards (IRBs)

IRB Name
IRB Approval Date
IRB Approval Number
Analysis Plan

Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
Yes
Intervention Completion Date
September 15, 2020, 12:00 +00:00
Data Collection Complete
Yes
Data Collection Completion Date
April 01, 2021, 12:00 +00:00
Final Sample Size: Number of Clusters (Unit of Randomization)
Not applicable.
Was attrition correlated with treatment status?
No
Final Sample Size: Total Number of Observations
22,817 households
Final Sample Size (or Number of Clusters) by Treatment Arms
7,456 were assigned to one email, 7,407 were assigned to two emails, and 7,954 were assigned to three emails.
Data Publication

Data Publication

Is public data available?
No

Program Files

Program Files
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials