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College of Law Professor and Collaborators Receive $388,244 Grant to Study Health Insurance Purchasing Behavior

​​Professor Wendy Netter Epstein, DePaul University College of Law Professor and Associate Dean; Dr. Christopher Robertson, Professor at Boston University School of Law; and Dr. David Yokum, Director of The Policy Lab at Brown University have jointly been awarded a $388,244 grant from the Robert Wood Johnson Foundation Evidence for Action program in support of a new, two-year, multi-phase research project, “Examining the proactive use of 'generosity framing' in encouraging young and healthy individuals to purchase health insurance." To be administered by DePaul and running from July 2021 through June 2023, it will be the first empirical project to explore whether generosity framing—playing on the desire to be altruistic or socially responsible by explicitly telling uninsured consumers that their policy purchases will subsidize insurance for the sick—effectively enhances insurance uptake.

“The U.S. has an uninsured problem," says Professor Epstein. “Even before the pandemic, nearly 30 million Americans were uninsured, and COVID-related job losses and the economic downturn exacerbated it at the worst time. With fewer people having access to employer-sponsored coverage, more Americans should be turning to the Exchanges to purchase policies. The new Biden Administration subsidies are helping, but without universal coverage, too many are still uninsured. A core goal of the study is to identify the characteristics of individuals, with an emphasis on the young and healthy, who are more likely to purchase insurance when it is marketed as the generous or altruistic choice."

Using a three-phase approach, the researchers will first conduct focus groups in two partner states, Rhode Island and Massachusetts, to understand consumer perspectives and to optimize the presentation of these ideas. In the second phase, the researchers will conduct a randomized field experiment using internet advertisements, studying actual consumer behaviors. The final phase will partner directly with Health Benefit Exchange in Maryland and Healthsource RI in Rhode Island, incorporating insights from the prior phases to manipulate direct mail and email marketing materials for uninsured residents and to observe differences in health insurance purchasing behavior.

“Generosity framing has not been directly tested for health insurance purposes," says Professor Epstein. “But positive effects have been found in other domains and generosity and social responsibility are concepts increasingly used to market all sorts of products. In health specifically, Americans already overwhelmingly support laws that require insurers to sell policies to those with pre-existing conditions without charging them more. This only works if healthy people also purchase policies."

Black and Hispanic populations are more likely to be uninsured. A primary goal of this research is to better understand how people will respond to generosity framing, with a key emphasis on addressing racial and ethnic disparities in health insurance uptake. The researchers are committed to studying a diverse population and to conducting phases of the project in both English and Spanish. “If generosity framing is effective," Professor Epstein says, “our findings have the potential to be readily adopted in our partner states and more broadly. Results will also inform efforts to ultimately achieve a universal coverage system."

Disclaimer: Support for this work was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.