My must read of the day is "The death of Obamacare’s death spiral," by Ezra Klein in the Washington Post:
4. The risk of a "death spiral" is over. The Kaiser Family Foundation estimates that if the market's age distribution freezes at its current level -- an extremely unlikely scenario -- "overall costs in individual market plans would be about 2.4 percent higher than premium revenues." So, in theory, premiums costs might rise by a few percentage points. That's a problem, but it's nothing even in the neighborhood of a death spiral.
The risk of a death spiral can’t be deemed "over" based on the demographic information provided by the Department of Health and Human Services. While the federal government runs, or partially runs, the exchanges of 36 states, there is not a national health insurance plan. The Bronze plan an individual in Georgia buys on healthcare.gov will not enroll them in the same plan as someone in Nebraska, who also purchases a Bronze plan through healthcare.gov. You cannot purchase insurance plans across state lines.
The young, healthy person in Georgia isn’t going to pay for the insurance of an older, sick person in Nebraska, or any other state. Same goes for the young, healthy person in Nebraska.
A national ratio has little value. It helps give us an idea of who is enrolling, but it doesn’t give information to determine if there are enough young, healthy enrollees. In order to make that determination, we have to have demographic information from each state.
For this reason, comparing the ratio to the program in Massachusetts is not particularly helpful. That ratio actually gave an indication of enrollment because the demographic was within a single state. The possibility of a death spiral lives.