None of this means that unexpectedly low enrollment from healthy people would be a good thing—or without consequences. Premiums would rise, potentially increasing the cost of federal subsidies and/or premiums for people buying coverage without federal tax credits. But the increases would not be disastrous. And that’s a pretty good lesson to remember. People tend to talk about Obamacare as if it’s going to be a ringing success or a total catastrophe. In reality, it’s likely to be a mix of good and bad news, with lots of variation from state to state, and with lots of unanswered questions that linger for months and even years.
Philip Klein reframes the death spiral debate:
[W]hat’s been largely lost in the ongoing discussion about whether a death spiral can happen is that there isn’t one Obamacare “risk pool” and thus, there isn’t one potential “death spiral.”
In reality, there are 51 different risk pools (for each state plus the District of Columbia), which means 51 chances to get things right, as well as 51 possible death spirals.
It’s perfectly possible that come March 31 – the current end of the open enrollment period – evidence will show a bit of both. That is, some exchanges may be viable, and some may find themselves in deep trouble.
Larry Levitt of Kaiser looks ahead:
I expect a mixture of stories at the beginning of January. There will likely be reports of some remaining errors in the back-end transmissions to insurers, with some people thinking they’re enrolled when they’re not. And, as I said, some people will be surprised by which providers are or are not in their plans. Some people may also start to discover that they have enrolled in plans with modest premiums but high deductibles, which may not cover their more routine medical expenses. At the same time, we’ll start hearing many more stories than we have to date about people who have signed up and getting help that wasn’t available before. That will include people with pre-existing conditions who have been locked out of insurance before, or low- and middle-income people who are getting tax credits that make coverage much more affordable. What we’ll start to see in January are the real effects of the law, rather than the more hypothetical ones we’ve been talking about up until now.