Reaching the Unreachable: Insuring the Remaining Uninsured in Massachusetts
Aquino Argueta, Seciah Michelle
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AbstractMassachusetts led the country with its 2006 health care reform initiative and, over the past twelve years, has made tremendous progress in insuring the uninsured. It has successfully reduced the percent of those without coverage to 2.5%, the lowest rate in the United States (Barnett & Berchick, 2017). Despite slight variations, the uninsurance rate has largely remained stagnant since 2008. Data from the DOR show that two-thirds of the uninsured have incomes below 150% of the FPL (MA DOR, 2007). At this level, the uninsured would be eligible for free health insurance through Medicaid or through state subsidies. Lack of coverage is seen at higher rates for people of color, particularly young Latinxs, and this gap has persisted over time even though Massachusetts has made dedicated efforts to close the racial and ethnic gap in coverage.
This DELTA project explored two formal approaches to increasing health insurance access to the remaining uninsured in Massachusetts: a creative marketing and outreach approach and a strict policy approach. The marketing approach focused on a deep assessment of the Archipelago campaign, a targeted marketing campaign undertaken by the Health Connector during the 2016–2017 OE period. The policy approach examined the potential for Massachusetts to strengthen its individual mandate by applying policies similar to those of the Netherlands and Switzerland, two countries that have nearly achieved universal coverage.
The impact of the Archipelago campaign was explored using a quasi-experimental design study with matched controls. In order to isolate the effect of the intervention, a Difference in Difference analysis was run. The results show a statistically significant association between the Archipelago campaign and enrollment gains in target communities between 2016 and 2017. On average, 304 (95% CI: 143–465, p: 0.0004) new enrollees and 595 (95% CI: 416–774, p < 0.0001) total enrollees per target community, can be attributed to the Archipelago campaign.
This work furthers current health communication research by demonstrating the importance of intentionally targeting population type and using their preferred communication networks. Only a holistic approach -combining policy and outreach solutions- will address the diverse needs of communities across the state.
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