SHADAC Expertise

The Marketplace Enrollee Survey Item Matrix (MESIM)

Following the 2014 implementation of several key provisions of the Affordable Care Act (ACA), health policy researchers, government agencies and members of the public became interested in the impact of reform-related changes in health insurance coverage. These changes include:

• Enrollment in the new health insurance marketplaces

• Transitions in coverage

• Consumers’ experiences with the enrollment process, reasons for transitions and reasons for remaining uninsured given the availability of expanded health insurance coverage

SHADAC has compiled a matrix of marketplace-relevant survey questions used in various state, federal and private surveys. The Marketplace Enrollee Survey Item Matrix (MESIM) provides example survey question wording for:

• Insurance coverage transitions

• Experiences with new coverage options

• Application pathway and information-seeking

• Reasons for lack of insurance

The MESIM draws primarily from national surveys, but it includes questions from several state surveys as well. Although not exhaustive, the questions included are a good representation of questions focused on measuring individual's experiences under the ACA.

The MESIM builds on a related survey question matrix for monitoring ACA progress in state surveys—the State Reform Survey Item Matrix (SRSIM)—which covers a broader list of domains including:

• Access

• Affordability

• Emergency department use

• Employer sponsored insurance

• Health reform knowledge

• Medical homes

  • Utilization

The MESIM was developed by SHADAC through support of the Robert Wood Johnson Foundation's State Health Reform Assistance Network ("State Network").

Download the MESIM.

How the MESIM Works

The MESIM is a Microsoft Excel file with sort and filter functions that allow users to browse or search for survey questions. The matrix enables comparison of metrics among surveys and provides a resource for deciding what metrics to include in future surveys.

The MESIM contains four columns in the "Survey Item Matrix" tab:

1. Domain—The broad measurement areas included in the matrix. Categories include:

Access and Provider Supply—Metrics that capture respondent's confidence in accessing care, availability of providers (e.g., providers accepting one's insurance/new patients) and use of insurance coverage.

Application Pathway—Measures related to experiences navigating the health insurance application process (primarily in the Marketplace/exchange), including knowledge of enrollment resources, information-seeking, use of Marketplace resources, shopping for health plans, reasons for using/not using the Marketplace and overall satisfaction with the process.

Barriers to Care—Metrics used to determine respondent's ability to pay for insurance coverage and/or health services; financial problems caused by healthcare; and difficulty paying medical bills.

Coverage Type—Metrics that capture insurance coverage status, source of coverage, duration of coverage (or lack of coverage), whether coverage was obtained through the Marketplace/exchange and whether respondent received financial assistance through the Marketplace/exchange.

Health Coverage Literacy—Measures that assess respondent's understanding of common health insurance terms.

Motivation to Enroll—Metrics about why people chose to enroll in a particular coverage option.

Perceptions of Quality/Satisfaction—Items measuring respondent's perceptions of the quality of his/her health insurance coverage, satisfaction with this coverage and ability to pay the insurance premium.

Reasons for Transitions/Motivation to Enroll—Metrics that capture reasons for/motivation to enroll in/and choice of new coverage, as well as the availability of alternatives to the Marketplace/exchange.

Reasons for Uninsurance/Intent to Enroll Among Uninsured—Items that assess reasons for uninsurance, reasons for not signing up for new coverage/not maintaining new coverage and intent to enroll in new coverage.

2. Desired Metric—Represents more specific topic or question areas within each domain. 

3. Survey Source—Shows the survey name and year. 

4. Exact Metric/Survey Question—Contains the variable name (highlighted in red) with exact survey question and response options from each data source. Cells may contain multiple survey questions from the same data source used to capture the desired metric.

How to Use the MESIM

Sort and filter shortcuts are conveniently embedded in each column of the MESIM. To access these options, click on the box with an arrow on the upper right side of each column (row 2). 

Helpful Hints

• Multiple columns can be filtered at the same time to view more specific details

• If there are two arrows in the box on the right side of a column heading, it means that column is already sorted alphabetically

• If there is an arrow and a filter in the box on the right side of a column heading, it means that items in that column have been filtered so the column does not show all the items in the matrix


• Includes selected measures of interest from a variety of state, federal and private surveys
• Does not contain items from all state or federal surveys related to health insurance, coverage transitions or the marketplace
• Does not contain all measures from the surveys it draws from

• Does not provide an evaluation of the psychometric properties of any of the items to determine the validity or reliability of data obtained

• Items are taken out of the context of their placement in the source survey. Items are sensitive to order and context effects (i.e., that the meaning of the question is influenced by its placement in the survey)
   - We suggest using the hyperlink to the source survey (see "List of Source Surveys") tab to review item placement within the original survey

• SHADAC does not make recommendations for use of any particular items.


This tool was developed through support of the Robert Wood Johnson Foundation's (RWJF) State Health Reform Assistance Network (State Network). The State Network is dedicated to providing technical assistance to states to maximize coverage expansion under the ACA. The program and the dissemination of models and lessons learned from this work are key elements of RWJF's goal of ensuring that nearly all Americans have health coverage by 2020. The State Network is managed at Princeton University's Woodrow Wilson School of Public Health and International Affairs with significant support from State Coverage Initiatives, also an RWJF national program, housed at AcademyHealth.