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

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.