1. The mix of enrollees
Insurers say that people signing up for insurance through the new exchanges tend to be older and unhealthy. This is bad news for the Obama administration, which has stressed that younger enrollees are crucial to making the law work since they offset the costs of insuring older, sicker individuals. Early on, the White House said its goal was to have young people make up about 40 percent of total enrollees. However, the latest enrollment figures through March reveal they only make up about 27 percent of total enrollees.
Insurers have previously sounded alarms that if the administration doesn’t get enough young and healthy people to sign up, a so-called “death spiral” could occur. Though most insurers and even critics of the law don’t think a death spiral will happen, they are concerned that the enrollees — who skew older — will be a factor in raising the cost of premiums next year.