Moral Framing and Affirmative Outreach as Drivers of Health Insurance Enrollment in Medicaid and a State Exchange: A Randomized Field Experiment

Wendy Netter Epstein (DePaul University), Christopher T. Robertson (Boston University), David Yokum (Brown University), Hansoo Ko (New York University), et al., Moral Framing and Affirmative Outreach as Drivers of Health Insurance Enrollment in Medicaid and a State Exchange: A Randomized Field Experiment (2023):

Legal efforts to expand health insurance coverage have relied on traditional economic theory. Despite expanded subsidies and some state mandates, nearly 30 million Americans are uninsured, including many who could afford it. Where economic self-interest has not fostered enrollment, we test whether moral framing around community or responsibility could be more effective. 
We present a pre-registered field experiment with a state government (Maryland) dataset of uninsured residents (N=16,477). We randomized to four conditions: (a) no-contact control, (b) affordability messaging (status quo), (c) responsibility messaging, or (d) community messaging, and found responsibility and community messages most effective (an 18.5% change).