Beyond Subsidies and Mandates: Testing a Simple Behavioral Mechanism to Drive Health Insurance Coverage

Abstract Uninsured individuals face reduced access to care, financial risk, and higher mortality. Although public programs and private subsidies have lowered uninsurance, these mechanisms remain incomplete and politically unstable. We evaluate whether a low-cost outreach intervention can increase health insurance enrollment without altering plan prices. Using a randomized field experiment involving 16,477 uninsured Maryland households, we assigned households to a no-contact control or to receive email and postcard outreach featuring affordability messaging alone or combined with responsibility or community framings. Outreach increased qualified health plan enrollment by 0.699 percentage points and total coverage by 0.967 percentage points relative to control. The intervention produced one additional enrollment per $80 spent, implying an estimated cost per life saved of approximately $125,000—substantially below conventional valuations of a statistical life. The results demonstrate that inexpensive outreach can yield measurable welfare gains. Effects of moral framing are only suggestive for future research.