A New York Times story this week describes how a simple nudge by the Treasury Department led to increased enrollment in health insurance coverage and decreased mortality. In December 2016 and January 2017, the Internal Revenue Service sent letters to 3.9 million people who had paid a tax penalty for lacking health insurance coverage, letting them know how to avoid the penalty in the future and providing information on how to enroll in coverage.
The unique circumstances of the communication allowed for a control experiment on the results of this approach. Originally, the IRS intended to send letters to 4.5 million households, but budget constraints limited how many letters they could send. Three economists at the Department took this as an opportunity to study the effects of sending such a letter. They found that not only did the intervention result in increased enrollment in health insurance coverage, but also that having coverage reduced mortality, particularly among middle-aged adults.
Most significantly, the researchers found that one life was saved for every 1,648 individuals who received the letter – about 700 saved lives saved in total. This study affirms the AHA’s core value of the importance of health insurance coverage, as well as the need for increased outreach and enrollment assistance for the remaining uninsured. As we come to the close of another open enrollment period for the individual market on Sunday, Dec. 15, we encourage everyone in need of coverage to visit healthcare.gov to find a health plan that is right for you. And for those of you already covered, we hope you will visit www.aha.org/getcovered to learn how you can help spread the word.
We also urge our federal partners to take note of this study and do more to close the remaining coverage gap. In 2018, the uninsured rate rose for the first time since 2009; the number of people who enrolled in plans through the marketplaces fell for the third straight year; and — most concerning — nearly half a million more children were uninsured in 2018 than in 2017. These trends are moving in the wrong direction, but there is a lot that can be done to turn things back around. We can start by restoring funding for outreach and enrollment efforts to make sure that individuals know about their coverage options – and are able to easily sign up.
This is an all-hands-on-deck effort. That is why, in addition to the enrollment materials on our website, the AHA, for the third year in a row, has put our own resources into running radio ads in English and Spanish in five crucial states around the nation, along with a digital campaign.
Please join us is working to improve access to quality health care and coverage in our communities so that together we advance health in America.
Ariel Levin is a senior associate director for state issues at the AHA.