Association for Public Policy Analysis & Management

Television advertising of Affordable Care Act (ACA) health plans has had a substantial impact on directing consumers to application assistance and enrollment. Prior to the ACA, Latinx adults, especially immigrant and Spanish-speaking adults, faced the highest rates of uninsurance and lower awareness of ACA provisions and enrollment resources. Our objective was to assess how and where Spanish-language ads were targeted and what enrollment assistance resources were emphasized. We used Kantar Media/CMAG data from the Wesleyan Media Project to 1) describe the sponsorship, geographic distribution, and volume of Spanish- vs. English-language Marketplace television ads across Open Enrollment Periods (OEP)1-3 (2013-14, 2014-15, 2015-16), and 2) examine how enrollment resources (in-person/telephone assistance vs. online) were differentially targeted by language. Spanish-language ads made up 10% of all airings and were more likely to be sponsored by State-based Marketplaces (47%), while insurance companies sponsored 55% of English-language airings. Spanish-language airings had 53% lower odds of mentioning online resources and 2.2 times higher odds of mentioning telephone/in-person enrollment assistance resources. While there was a significant decrease in mention of telephone/in-person assistance over time for English-language airings (71.4% in OEP1 to 54.7% in OEP3), these mentions increased significantly in Spanish-language airings (71.0% to 84.8%). Even within ads with the same type of sponsor, there was large variation by language in mention of telephone/in-person assistance. We found evidence that sponsorship of and messaging in ACA television advertising differed significantly by language. Future research should examine the impact of recent, drastic federal cuts to ACA outreach/marketing on Spanish-language advertising.