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 included enrollment in the new health insurance marketplaces, transitions in coverage, and consumer experience 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 an 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                                                                           • Utilization
• Affordability                                                                 • Health reform knowledge
• Emergency department use                                      • Medical homes
• Employer sponsored insurance  


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 file allows users to sort and filter by four columns:

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

• Access and Provider Supply
• Application Pathway
• Barriers to Care
• Coverage Type
• Health Coverage Literacy
• Motivation to Enroll
• Perceptions of Quality/Satisfaction
• Reasons for Transitions/Motivation to Enroll
• Reasons for Uninsurance/Intent to Enroll Among Uninsured

• Desired metric
• Survey source
• Exact metric/survey question


Further details about the MESIM file can be found in the tabs listed below:

• Tab 1: Purpose
• Tab 2: Description
• Tab 3: How to Use
• Tab 4: Marketplace Survey Item Matrix (main tab)
• Tab 5: List of Source Surveys 
• Tab 6: Limitations
• Tab 7: Related Resource
• Tab 8: Acknowledgments


Acknowledgment: This tool was developed with support from the Robert Wood Johnson Foundation's (RWJF) State Health Reform Assistance Network (State Network).