Attacks on ACA may have accidentally helped enrollment

Fear of losing subsidized coverage may have boosted enrollment

A $450 million effort to derail the anti-Affordable Care Act (ACA) may have inadvertently boosted enrollment in states where Senate Democrats are up for re-election in 2014, according to an analysis by the Brookings Institution.

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Writing in Brookings' "TechTank" blog last week, fellow Niam Yaraghi explored a report conducted by non-partisan Kantar Media CMAG on how $450 million was spent on anti-ACA advertisements.

Spending on negative advertisements outpaced pro-ACA ads by more than 15-to-1, according to Kantar's report.

Looking at the report's map of where anti-ACA advertisement spending was most concentrated, the four states with the highest per capita spending on anti-ACA ads were Kentucky, Arkansas, Louisiana, and North Carolina—all states where midterm Senate elections are expected to be very competitive. (Yaraghi excludes the District of Columbia and Vermont since those areas had abnormally high ad spending per capita.)

Comparing the map to HHS data on where the more than eight million ACA enrollees are concentrated, Yaraghi created a chart to explain how anti-ACA ad spending per capita may have influenced enrollment in the federal and state health insurance exchanges. 

In Yaraghi's chart the blue dots represent states where Senate Democrats are up for re-election in 2014, the red dots represent states where Republicans are up for re-election, and the green dots represent states with no midterm elections in 2014. According to the chart, while the ads may have discouraged enrollment in states where Republican senators are running for re-election, the ads may have boosted enrollment where Democratic senators were already holding a seat.

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"In fact, after controlling for other state characteristics such as low per capita income population and average insurance premiums, I observe a positive association between the anti-ACA spending and ACA enrollment," Yaraghi wrote, adding that the ads "may unintentionally increase the public awareness about the existence of a governmentally subsidized service and its benefits for the uninsured."

Moreover, residents living in states with the most anti-ACA ads were more likely to believe that Congress will repeal the ACA and are at a "greater willingness to take advantage of this one time opportunity," Yaraghi wrote (Yaraghi, "TechTank," Brookings Institution, 7/9).

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