Search and You Shall Find: Geographic Characteristics Associated with Google Searches during the Affordable Care Act's First Enrollment Period

Previous studies indicate that Internet searching was a major source of information for the public during the launch of the Affordable Care Act, but little is known about geographic variation in searching. Our objective was to examine factors associated with health insurance-related Google searches in 199 U.S. metro areas during the first open enrollment period (October 2013 through March 2014), by merging data from Google Trends with metro-area-level and state-level characteristics. Our results indicate substantial geographic variation in the volumes of searching across the United States, and these patterns were related to local uninsurance rates. Specifically, areas with higher uninsurance rates were more likely to search in higher volumes for "Obamacare" and "health insurance," after adjusting for sociodemographic, political, and insurance market characteristics. The enormous political, advocacy, and media attention to the Affordable Care Act's launch may have contributed to heightened Internet search activity, particularly in areas characterized by higher uninsurance.