healthcare.gov home screen as of March 28, 2019

The healthcare.gov home screen as of March 28, 2019. 

In the last few years, a chasm opened between those who get financial help with Affordable Care Act health insurance and those who can’t.

The “can’t” category includes a hypothetical Lancaster County family of four — 40-year-old parents and two teenagers — with household income of $100,500.

Because they earn just a little too much to qualify for subsidies, their cheapest 2019 healthcare.gov option costs almost $17,700 — and that’s just the premiums. Costs are even higher for older people.

The Trump administration this week released data showing that while subsidized enrollment grew from 2015 to 2018 in Pennsylvania and nationwide, the number of plans sold at full price dropped sharply.

Here are some takeaways.

Almost in half

In Pennsylvania, the number of full-price enrollees nearly halved in that time, dropping from about 295,000 to 156,000.

That includes ACA-compliant plans sold outside healthcare.gov. County-level numbers were not provided.

Meanwhile, subsidized enrollment statewide grew from 290,771 to 299,649.

No solution

Centers for Medicare & Medicaid Services Administrator Seema Verma said the drop “proves that Obamacare’s sky-high premiums are unaffordable.”

The news release said the administration “remains firmly committed to helping those harmed and providing every American with more affordable health care options” but did not note any specific proposals to help unsubsidized people.

Fate unclear

It’s not clear whether the unsubsidized people who no longer have ACA plans have gotten jobs that provide insurance, obtained some skimpier form of coverage or are uninsured.

However, Pennsylvania Insurance Department spokesman Ron Ruman noted in an email that the uninsured rate is the state’s lowest ever, at 5.5%.

"Over the past three years the uncertainty around the Affordable Care Act at the Federal level has caused large fluctuations in the market and as a result we have seen an increase in rates," said Pennsylvania Health Access Network executive director Antoinette Kraus, noting that the increases "have been felt the hardest by those who have unsubsidized coverage often forcing individuals to go without."

Sharp cliff

Another possibility is that some people strategically used pre-tax retirement contributions to lower household income enough to qualify for financial help if they saw they were going to be above the cutoff.

The difference can be huge. If the hypothetical family above had household income of $100,400 — just $100 lower — it would qualify for help cutting its annual premiums by nearly $14,700, to just under $3,000.