Competing public and private television advertising campaigns and marketplace enrollment for 2015 to 2018

The Affordable Care Act was a landmark political achievement in reforming the American health insurance system but has been subject to considerable political pressure. Administrative actions, such as eliminating federal advertising, have served as a replacement for failed legislative repeal efforts. We use a county-level fixed-effects model with data for thirty-four states for the 2015 to 2018 open enrollment periods to measure dose-response relationships between health insurance and health-care-related political advertising and Marketplace enrollment. State-sponsored advertising is related to greater Marketplace enrollment, but we find no association between federal advertising and enrollment. We are, however, unable to account for the endogeneity of advertising decisions across media markets and potential federal coordination with other sponsor types. These results have implications for understanding public roles within privatized policy implementation.