Drafters of the Patient Protection and Affordable Care Act (PPACA) wanted to give poor people easier access to care, and they wanted to give higher-income consumers enough “skin in the game” to make those higher-income consumers better health care shoppers.

The goal was to mobilize armies of angry middle-income and upper-income patients to get providers to deliver better-coordinated, more cost-effective care.

Some of the changes — such as the rise of the health saving account (HSA) — have been sliding in for years, but others, such as the start of the PPACA health insurance premium subsidy tax credit program, have just begun to take effect this year.

Gallup has just published results of a series of telephone surveys of 828 U.S. adults conducted from Nov. 6 through Nov. 9. The results show that the PPACA program design decisions may have produced outcomes that will shock the people who drafted PPACA — and lead many agents and brokers to nod your heads and say, “I told you so.”

Barbed wire fence

1. Twenty-two percent of the survey participants said they have put off treatment for what they believed to be a serious condition in the past 12 months. 

That’s up from 19 percent a year earlier. It’s up only slightly from 21 percent in 2010, when the effects of the Great Recession on the job market were peaking, but it’s up from a range of 16 percent to 18 percent from 2004 through 2009.

See also: CDC: Ranks of Uninsured Continue to Grow

Leaky umbrella

2. Insured Americans had holes in their risk protection umbrellas.

Bill Carpenter, the chief executive officer at LifePoint (Nasdaq:LPNT), a for-profit hospital company, recently reported that the PPACA Medicaid expansion program was helping to reduce the number of patients who came in with no insurance at all, but that the company was having to increase allowances for insured patients who would have problems paying deductibles, co-payments and coinsurance amounts.

The Gallup survey adds context to Carpenter’s comment.

Gallup found that the percentage of survey participants who reported putting off any sort of medical treatment because of cost fell to 57 percent this year for the uninsured, from 59 percent in 2013.

The percentage of people with Medicare or Medicaid who put off getting care because of cost held steady at 22 percent.

The percentage of privately insured people who put off getting care because of cost jumped to 34 percent, from 25 percent. 

Some going up the stairs and some going down

3. Perceptions of access problems have turned upside down.

In the past, researchers at the Commonwealth Fund and other organizations found that low-income people reported much more serious obstacles to getting needed care than higher-income people.

Gallup simply asked the participants in its surveys about their recollections of whether they or family members had put off getting needed care because of cost, and it made no effort to adjust those responses, to make sure it was comparing apples to apples.

But Gallup found a huge drop in reports of problems with access to care among low-income participants, and a huge increase among higher-income participants.

Only 35 percent of the participants with annual household income under $30,000 said they or family members have put off care in the past year because of cost, down from 43 percent a year earlier.

Among participants with household income of $75,000 or higher, 28 percent reported putting off care because of cost — up from 17 percent a year earlier. In other words: The absolute number of high-income Americans facing cost-related barriers to getting care has increased about 50 percent in the past year.

The percentage of participants with households in the $30,000-to-$74,999 income range who reported cost-related access problems increased to 38 percent, from 33 percent.

The leap was not as dramatic as for the high-income participants, but the middle-income participants were reporting more cost-related problems with access to care than the low-income participants did.