Community Characteristics and Qualified Health Plan Selection during the First Open Enrollment Period

Michel Boudreaux, Lynn A. Blewett, Brett Fried, Katherine Hempstead, Pinar Karaca-Mandic

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To examine state and community factors that contributed to geographic variation in qualified health plan selection during the first open enrollment period. Data Sources/Study Setting: Administrative data on qualified health plan selections at the ZIP code area merged with survey estimates from the American Community Survey. Study Design: Descriptive and regression analyses. Data Collection/Extraction Methods: Data were generated by healthcare.gov and from a household survey. Principal Findings: Thirty-one percent of the variation in qualified health plan selection ratios resulted from between-state differences, and the rest was driven by local area differences. Education, language, age, gender, and the ethnic composition of communities contributed to disparate levels of plan selection. Medicaid expansion states had a qualified health plan selection ratio that was 4.4 points lower than non-Medicaid expansion states, controlling for covariates. Conclusions: Our results suggest community-level differences in the intensity or receptiveness to outreach and enrollment activities during the first open enrollment period.

Original languageEnglish (US)
Pages (from-to)1223-1238
Number of pages16
JournalHealth services research
Volume52
Issue number3
DOIs
StatePublished - Jun 2017

Bibliographical note

Funding Information:
Joint Acknowledgment/Disclosure Statement: This project was supported, in part, by a grant from the Robert Wood Johnson Foundation to the State Health Access Data Assistance Center. We thank Karen Turner for excellent GIS support and the editors and three anonymous reviewers for their comments. Disclosures: None. Disclaimers: None.

Publisher Copyright:
© Health Research and Educational Trust

Keywords

  • Health insurance marketplace
  • qualified health plan

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