Date of Award

January 2015

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Mark Schlesinger


The state-based exchanges created under the Affordable Care Act are not passive marketplaces that merely offer health insurance plans; they also endeavor to provide support to consumers in selecting those plans that best fit their healthcare needs. This paper examines the method by which six state-based exchanges (Connecticut, Maryland, Massachusetts, New York, Rhode Island, and Vermont) attempt to accomplish this goal using their online shopping infrastructure, also known as a decision-support tool. First, these decision-support tools are qualitatively compared in order to access the design choices made by policymakers and relate those design choices to how they may impact consumer choice. Second, an online sample was asked to select an insurance plan based on a fictional health scenario within a randomly assigned decision-support tool in order to compare how often these tools facilitate the consumer into selecting a plan that rationally fits with their health insurance needs.

Although superficially the design of many of these decision-support tools is similar, there are important differences with regard to the default plans that are initially displayed, as well as the way in which plan information is presented to the consumer. Likely as a result of these design choices, individuals randomized to different exchanges picked widely different plans with regard to overall plan generosity (measured by medal level/actuarial value), and some states (Rhode Island and Vermont) appeared to facilitate the selection of rationally appropriate plans far more often than others. States were also generally more successful at matching individuals to plans when the default options displayed by the exchange were near in actuarial value to the rationally appropriate plan, even if individuals did not select one of the initial default options.


This is an Open Access Thesis.

Open Access

This Article is Open Access