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California Affordable Care Act Case Study

The Situation

Covered California is the state exchange responsible for administering and marketing the Affordable Care Act in California. Becky Quarles provided design and analytic services, as well as marketing consultation to NORC at the University of Chicago, which was responsible for conducting marketing research for the launch and subsequent years for Covered California. 

The Process

Becky Quarles worked closely with NORC on questionnaire design, segmentation analysis, report writing, presentations, and consultation for Consumer Market Baseline Segmentation Study (2013) and the first (2014) and second (2015) tracking studies. She collaborated not only with NORC but also with Covered California’s advertising and public relations agencies, as well as with Covered California. This involved defining segments, according to both targetable variables, such as demographics, geographic location, media behavior, etc.) and non-targetable variables (product-specific motivations, lifestyles, and attitudes). This segmentation analysis identified the most effective communication vehicles and messages for each segment. 



The performance of the Affordable Care Act (ACA) has varied dramatically by state. The financial performance of health insurance programs depends largely on enrolling enough younger, healthier people, who use fewer health care services, to offset the costs of providing care for those who need more health care services. Unless a program can accomplish this, it must raise rates, which decreases enrollment, particularly among the younger, healthy people. This creates a downward spiral.


Covered California is one of the few ACA health care exchanges that has avoided this potential hazard; and its performance is largely due to its effective marketing and outreach campaign.


The Washington Post named California as the “best state in America” for its smooth rollout of the ACA. More than 2.5 million people signed up for coverage during the first six months of open enrollment; and more than 42 percent of those eligible to sign up, did so. Medicaid enrollment jumped almost 16 percent, but “California was one of only six states to grow their private insurance rolls more than their Medicaid numbers, even though they accepted federal dollars to expand Medicaid.”

There was even better news: A survey by the Commonwealth Fund showed that the percentage of Californians without health insurance was cut in half during the Covered California’s first open enrollment period (from 22% to 11%). By contrast, the U.S. uninsured rate dropped just 25 percent (from 20% to 15%). Clearly, a number of factors, including Covered California’s relatively bug-free website, contributed to this dramatic drop in the uninsured rate; but it is also clear that its research-based advertising and outreach program played a major role.

The percentage of Californians without health insurance has continued to decline. At the end of the 2018 enrollment period, the uninsured rate stood at 7.2%, compared to 22% before the ACA was launched. Despite efforts to dismantle the ACA, it continued to decline during 2018 (7.6% to 7.2%). Only two other states, New York and Louisiana, experienced declines in the uninsured rate during 2018.




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