Assessing the content of television health insurance advertising during three open enrollment periods of the ACA

Colleen L. Barry, Sachini Bandara, Kimberly T. Arnold, Jessie K. Pintor, Laura M. Baum, Jeff Niederdeppe, Pinar Karaca Mandic, Erika Franklin Fowler, Sarah E Gollust

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Television advertising has been a primary method for marketing newhealth plans available under the Affordable Care Act (ACA) to consumers. Data from Kantar Media's Campaign Media Analysis Group were used to analyze advertising content during three ACA open enrollment periods (fall 2013 to spring 2016). Few advertisement airings featured people who were elderly, disabled, or receiving care in a medical setting, and over time airings increasingly featured children, young adults, and people exercising. The most common informational messages focused on plan choice and availability of low-cost plans, but messages shifted over open enrollment cycles to emphasize avoidance of tax penalties and availability of financial assistance. Over the three open enrollment periods, there was a sharp decline in explicit mentions of the ACA or Obamacare in advertisements. Overall, television advertisements have increasingly targeted young, healthy consumers, and informational appeals have shifted toward a focus on financial factors in persuading individuals to enroll in marketplace plans. These advertising approaches make sense in the context of pressures to market plans to appeal to a sufficiently large, diverse group. Importantly, dramatic declines over time in explicit mention of the law mean that citizens may fail to understand the connection between the actions of government and the benefits they are receiving.

Original languageEnglish (US)
Pages (from-to)961-989
Number of pages29
JournalJournal of health politics, policy and law
Issue number6
StatePublished - Dec 1 2018

Bibliographical note

Funding Information:
Jeff Niederdeppe is associate professor of communication at Cornell University. His research examines the mechanisms and effects of mass media campaigns, strategic health messages, and news coverage in shaping health behavior, health disparities, and social policy. He has published over 125 articles in communication, public health, health policy, and medical journals, and his work has been funded in recent years by the National Institutes of Health, National Science Foundation, Environmental Protection Agency, and Robert Wood Johnson Foundation. He is an associate editor of Communication Methods and Measures and serves on the editorial boards for eight other journals.

Funding Information:
Colleen L. Barry is Fred and Julie Soper Professor and chair of the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health. Her research examines on how health and social policies can affect a range of outcomes, including access to medical care and social services, care quality, health care spending, financial protection, and mortality. She conducts empirical research to understand how communication strategies influence public attitudes about health insurance, drug addiction, mental illness, gun policy, and obesity and food policy. A focus of this work is to identify evidence-based approaches to reducing stigma. Sachini Bandara is a postdoctoral fellow funded through the National Institute for Mental Health T32 Training Grant for Mental Health Services and Systems (MH109436; Multi PI: Barry/Stuart) at the Johns Hopkins Bloomberg School of Public Health. She conducts policy analysis with a focus on the health and well-being of vulnerable populations, including individuals with criminal justice involvement, mental illness, and substance use disorder. She also has an overarching interest in policy communication, public opinion, and message framing.

Funding Information:
Erika Franklin Fowler is associate professor of government at Wesleyan University and codirector of the Wesleyan Media Project. Her research examines the content and effect of media messaging in electoral and health policy contexts. Her work has appeared in such outlets as the American Journal of Political Science, Journal of Communication, and Health Affairs, and she is the coauthor of Political Advertising in the United States (2016). Her research in recent years has been funded by the Robert Wood Johnson Foundation, the John S. and James L. Knight Foundation, and the American Cancer Society.

Funding Information:
The authors received funding from the Robert Wood Johnson Foundation State Health Access Reform Evaluation (grant 72179, co–principal investigators SEG and EFF), Wesleyan University (LMB and EFF), Johns Hopkins Bloomberg School of Public Health (SB and KTA), and the McKnight Land-Grant Professorship, University of Minnesota (SEG).

Publisher Copyright:
© 2018 by Duke University Press.


  • Advertising
  • Health insurance
  • Local news
  • Media
  • Politics
  • Public opinion


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