Streamlined ACA Health Insurance Enrollment
Massachusetts Health Connector · Massachusetts, USA · 2021
Summary
Reducing enrollment to a single checkbox—rather than requiring a multi-step application—had the largest effect of any communication tested. Even a personalized letter with the applicant's name and pre-filled information outperformed generic outreach. The experiment reframes the enrollment problem: the barrier is the form, not awareness.
Research question
"Does a 'check the box' streamlined enrollment option outperform standard reminder letters?"
Methodology
Intervention
Three arms: streamlined one-click enrollment, personalized reminder letter, generic reminder letter
Assignment
Randomized controlled trial (individual)
Sample size
~50,000 uninsured eligible residents
Primary outcome
Health insurance enrollment rate
Effect estimate
Streamlined: +11 pp; Personalized reminder: +7.9 pp; Generic reminder: +4.5 pp vs. control
Decision
Streamlined enrollment made permanent feature of the Connector
Result
Positive
Streamlined: +11 pp; Personalized reminder: +7.9 pp; Generic reminder: +4.5 pp vs. control
Evidence strength
Strong
Randomized controlled trial with large sample.
Replication status
Partially replicated
Institution
Massachusetts Health Connector
Location
Massachusetts, USA
Year
2021
Policy area
Benefits Enrollment
Mechanism
Simplification