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Reducing Administrative Barriers Increases Take-up of Subsidized Health Insurance Coverage: Evidence from a Field Experiment

Author

Listed:
  • Keith Marzilli Ericson
  • Timothy J. Layton
  • Adrianna McIntyre
  • Adam Sacarny

Abstract

Administrative barriers to social insurance program take-up are pervasive, including in subsidized health insurance. We conducted a randomized controlled trial with Massachusetts’ Affordable Care Act marketplace to reduce these barriers and other behavioral frictions. We find that a “check the box” streamlined enrollment intervention raises enrollment by 11%, more than personalized reminder letters (7.9% increase) or generic reminder letters (4.5% increase). Effects are concentrated among individuals eligible for zero-premium plans, who faced no further administrative burdens of setting up payments. Producing this enrollment effect through premium reduction would cost about $6 million in subsidies, highlighting the importance of these burdens.

Suggested Citation

  • Keith Marzilli Ericson & Timothy J. Layton & Adrianna McIntyre & Adam Sacarny, 2023. "Reducing Administrative Barriers Increases Take-up of Subsidized Health Insurance Coverage: Evidence from a Field Experiment," NBER Working Papers 30885, National Bureau of Economic Research, Inc.
    • Handle: RePEc:nbr:nberwo:30885
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    References listed on IDEAS

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    1. Manasi Deshpande & Yue Li, 2019. "Who Is Screened Out? Application Costs and the Targeting of Disability Programs," American Economic Journal: Economic Policy, American Economic Association, vol. 11(4), pages 213-248, November.
    2. Nichols, Albert L & Zeckhauser, Richard J, 1982. "Targeting Transfers through Restrictions on Recipients," American Economic Review, American Economic Association, vol. 72(2), pages 372-377, May.
    3. Amy Finkelstein & Matthew J Notowidigdo, 2019. "Take-Up and Targeting: Experimental Evidence from SNAP," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 134(3), pages 1505-1556.
    4. Keith M. Marzilli Ericson, 2011. "Forgetting We Forget: Overconfidence And Memory," Journal of the European Economic Association, European Economic Association, vol. 9(1), pages 43-60, February.
    5. Saurabh Bhargava & Dayanand Manoli, 2015. "Psychological Frictions and the Incomplete Take-Up of Social Benefits: Evidence from an IRS Field Experiment," American Economic Review, American Economic Association, vol. 105(11), pages 3489-3529, November.
    6. Dague, Laura, 2014. "The effect of Medicaid premiums on enrollment: A regression discontinuity approach," Journal of Health Economics, Elsevier, vol. 37(C), pages 1-12.
    7. B. Douglas Bernheim, 2009. "Behavioral Welfare Economics," Journal of the European Economic Association, MIT Press, vol. 7(2-3), pages 267-319, 04-05.
    8. Damon Jones & David Molitor & Julian Reif, 2019. "What do Workplace Wellness Programs do? Evidence from the Illinois Workplace Wellness Study," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 134(4), pages 1747-1791.
    9. Henrik Jacobsen Kleven & Wojciech Kopczuk, 2011. "Transfer Program Complexity and the Take-Up of Social Benefits," American Economic Journal: Economic Policy, American Economic Association, vol. 3(1), pages 54-90, February.
    10. Adrianna McIntyre & Mark Shepard & Myles Wagner, 2021. "Can Automatic Retention Improve Health Insurance Market Outcomes?," AEA Papers and Proceedings, American Economic Association, vol. 111, pages 560-566, May.
    11. B. Douglas Bernheim & Antonio Rangel, 2009. "Beyond Revealed Preference: Choice-Theoretic Foundations for Behavioral Welfare Economics," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 124(1), pages 51-104.
    12. Richard Domurat & Isaac Menashe & Wesley Yin, 2021. "The Role of Behavioral Frictions in Health Insurance Marketplace Enrollment and Risk: Evidence from a Field Experiment," American Economic Review, American Economic Association, vol. 111(5), pages 1549-1574, May.
    13. Beshears, John & Choi, James J. & Laibson, David & Madrian, Brigitte C., 2008. "How are preferences revealed?," Journal of Public Economics, Elsevier, vol. 92(8-9), pages 1787-1794, August.
    14. Adrianna L. McIntyre & Mark Shepard & Myles Wagner, 2021. "Can Automatic Retention Improve Health Insurance Market Outcomes?," NBER Working Papers 28630, National Bureau of Economic Research, Inc.
    15. Amy Finkelstein & Nathaniel Hendren & Mark Shepard, 2019. "Subsidizing Health Insurance for Low-Income Adults: Evidence from Massachusetts," American Economic Review, American Economic Association, vol. 109(4), pages 1530-1567, April.
    16. Benjamin R. Handel, 2013. "Adverse Selection and Inertia in Health Insurance Markets: When Nudging Hurts," American Economic Review, American Economic Association, vol. 103(7), pages 2643-2682, December.
    17. Jacob Goldin & Ithai Z Lurie & Janet McCubbin, 2021. "Health Insurance and Mortality: Experimental Evidence from Taxpayer Outreach," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 136(1), pages 1-49.
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    Cited by:

    1. M. Kate Bundorf & Melissa McInerney & Kosali I. Simon & Ruth Winecoff, 2024. "Spillovers in Public Benefit Enrollment: How does Expanding Public Health Insurance for Working-Age Adults affect Future Health Insurance Choices?," NBER Working Papers 32675, National Bureau of Economic Research, Inc.
    2. Steffen Altmann & Andreas Grunewald & Jonas Radbruch, 2024. "The Double Dividend of Attention-Releasing Policies," CESifo Working Paper Series 11069, CESifo.
    3. Steffen Altmann & Andreas Grunewald & Jonas Radbruch, 2024. "The Double Dividend of Nudges," Rationality and Competition Discussion Paper Series 503, CRC TRR 190 Rationality and Competition.

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    More about this item

    JEL classification:

    • D73 - Microeconomics - - Analysis of Collective Decision-Making - - - Bureaucracy; Administrative Processes in Public Organizations; Corruption
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private

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