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High-Income Uninsured Health Market Grows 11%: Census Bureau

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What You Need to Know

  • The number of people with income over 400% of the federal poverty level fell 2.2% between 2019 and 2020.
  • The percentage of those relatively high-income people with private health coverage fell to 88.2%, from 88.8%.
  • About 8.9% of the high-income people were uninsured, up from 8.3% the year before.

The number of high-income U.S. residents who needed health insurance may have increased 11% between 2019 and 2020, to 4.9 million, according to new data from the U.S. Census Bureau.

That compares with an increase of 7.9%, to 28 million uninsured people, for the U.S. population as a whole.

The Census Bureau has published information about the number of people with private health coverage, public health coverage or no health coverage in a batch of results from the 2020 Current Population Survey.

The Current Population Survey

The Census Bureau polls about 60,000 households for the Current Population Survey program every month, to help the Bureau of Labor Statistics monitor the state of the workforce.

Survey managers included data on 325 million Americans in the results for 2019 and data on 326 million Americans in the results for 2020.

The new report breaks the results down by six different income categories. The highest is for people in households with income at or above 400% of the federal poverty level. That’s $51,040 for an individual, in most of the country, and $104,800 for a family of four.

Census Bureau officials note in a discussion of the new results that comparing the latest results with earlier results may be tricky, because the COVID-19 pandemic hurt the bureau’s ability to supplement the results from telephone interviews with in-person interviews.

The 2019 and 2020 Current Population Survey questionnaires distinguished between some types of health coverage, such as employer-paid coverage and coverage purchased through an Affordable Care Act public exchange, but the questionnaires did not distinguish between individual major medical insurance and other products that consumers might see as similar, such as short-term health insurance.

At or Above 400% of the Federal Poverty Level

The number of uninsured people in the highest income category may be of keen interest to health insurance agents, brokers and advisors, because high-income uninsured people may be in a better position than lower-income uninsured people to pay for individual or family coverage themselves.

The survey team found that the number of people with income at or above 400% of poverty fell 2.2% between 2019 and 2020, to 144 million.

For high-income people, the likelihood of having private health coverage fell to 88.2%, from 88.8%, between 2019 and 2020. About 19% of the high-income participants had coverage from Medicaid, Medicare or another public health program in both years.

The percentage of high-income people who were classified as uninsured increased to 8.9%, from 8.3%.

Results for Other Income Groups

In a second report, on household income, bureau officials noted that median U.S. household income fell 2.9% between 2019 and 2020, to $67,521.

High-income people did better at getting covered than two other income groups, about the same as two other income groups, and noticeably worse than one group.

Here’s how the numbers changed between 2019 and 2020 for each income group included in the data:

  • Under 100% of poverty: 6.4 million (up 19%)
  • Under 138% of poverty: 9.1 million (up 12%)
  • 100% to 199% of poverty: 7 million (down 3.9%)
  • 200% to 299% of poverty: 6 million (up 11%)
  • 300% to 399% of poverty: 3.7 million (up 3.7%)
  • 400% of poverty or higher: 4.9 million (up 11%)

2021 and Beyond

Analyzing the market for high-income people without major medical coverage, has been tricky, because the United States uses the same federal poverty level figures for all of the country but Alaska and Hawaii.

That means that prospects in the “high-income” category in Kansas City, Missouri, may be a different group of people than high-income prospects in San Francisco or Boston, which have much higher costs.

Another issue is that, from 2014 through 2020, the United States has had Affordable Care Act premium tax credit subsidies in place for people under the 400% of poverty level limit, but not for higher-income people.

This year, a COVID-19 response package included new, temporary premium subsidies for people over the 400% poverty level. The COVID-19 package provides subsidies that limit the percentage of income that all people, including high-income people, are expected to spend on health insurance premiums.

Congress has been considering proposals to make the subsidy program expansion permanent. How the extra subsidies has affected the number of high-income uninsured people this year could affect how likely Congress is to keep the subsidy program expansion in place.

(Image: Adobe Stock)