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.
2. Administrative rule changes impact enrollment numbers
When the president announced that people could stay on their non-ACA compliant policies through 2016, many Americans decided to keep their old plans, even though insurers assumed they would buy coverage on the new exchanges. Since these plans are less expensive and tend to be held by younger people, the change could mean that the risk pool will shift further toward older, sicker Americans.
“We’re exasperated,” an insurance executive told The Hill. “All of these major delays on very significant portions of the law are going to change what it’s going to cost.”