PPACA cuts off access to exchange plan subsidies for consumers who earn more than 400 percent of the federal poverty

The high cost of unsubsidized health coverage may be limiting health insurers’ ability to increase sales to Americans who look, to policymakers, as if they have plenty of cash to spend.

The uninsured rate for people with incomes over 400 percent of the federal poverty level fell to 4.8 percent in 2014, from 5.6 percent in 2013, but mainly because the number who had coverage from Medicare, Medicaid, the Children’s Health Insurance Plan (CHIP) program or another government plan increased, according to a new batch of 2014 Census Bureau data.

Patient Protection and Affordable Care Act (PPACA) programs and improvement in the economy helped cut the percentage of all Americans who lacked any form of public or private health coverage to 10.4 percent in 2014, from 13.3 percent in 2013, the bureau reports.

The number of people who lacked coverage fell 21 percent, to 33 million in 2014.

The number who had private individual or family coverage, purchased either through a PPACA exchange or off-exchange, jumped 29 percent, to 46 million.

In spite of concerns about the effects of PPACA on small-group plans, the number of people who had employment-based private coverage increased 0.3 percent, to 175 million.

But the bureau found that growth in use of private coverage varied by income level.

See also: PPACA subsidy gap hurts the moderately broke

PPACA provides subsidies that states can use to expand Medicaid and CHIP, and it also provides subsidies that consumers with incomes between 138 percent of the federal poverty level (FPL) and 399 percent of the FPL can use to pay for PPACA exchange plan coverage.

The number of high-income people who were uninsured fell to 5.6 million in 2014, from 6.5 million in 2013.

But the 14 percent drop in the number of high-income people who were uninsured was smaller than the 20 percent average for all Americans, and it was lower than the drop for any other income category broken out in a Census Bureau coverage-by-income table. 

See also: How PPACA squeezes moderately high income 60-year-olds

The number of Americans in the top income category increased 0.4 percent between 2013 and 2014, to 118 million, and the number of high-income people who had private coverage also increased 0.4 percent, to about 103 million. 

Meanwhile, the number of high-income people with government plan coverage increased 5.7 percent, to 2.6 million. 

See also: Underinsurance persisting in exchanges

Government plan enrollment also increased faster for people with incomes between 200 percent and 399 percent of FPL, but between private-plan and government-plan enrollment growth was much more dramatic for the high earners.

In the category for people with incomes from 200 percent of 299 percent of FPL, for example, private-plan enrollment increased 8.4 percent, and government plan enrollment increased 12 percent.

And, in the category for people with incomes from 300 percent to 399 percent of FPL, private-plan enrollment increased 1.3 percent, and government-plan enrollment increased 1.9 percent.