Enrollments for 2016 in insurance policies on the Affordable Care Act's (ACAs) exchange amount to 12.7 million Americans, only half of what was originally projected when the law passed.

These less than projected numbers speak to larger issues with the health care system overhaul, according to a recent article in Forbes. It is likely that the actual number of enrollments will fall below 12.7 million, based on data from previous years, when enrollment dropped 2% each month due to individuals not paying their premiums or dropping coverage midway through the year. 

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The effectiveness of the ACA depends not only on the number of enrollments, but also on the financial status of those who are enrolled. It is necessary to maintain a balance between people who qualify for subsidies and people who can pay premiums at full price. This is because the law made it illegal for insurers to charge premiums based on age or previous illness, and maintaining this balance enables insurers to offset the health care costs of older, ill, or injured people with the savings from younger and healthier people.      

Enrollment among the younger and middle class factions of the population, however, is low. According to Wharton economists in a University of Pennsylvania study, this is because health insurance for middle-income people now costs more than it did before the ACA, approximately $2000 to $3000 more for an individual making $40,000. This causes healthy people to opt to pay the penalty rather than enroll.

Americans who are either below the federal poverty line comprise the majority of enrollments on the exchange, causing insurance companies to suffer financial loses. Some companies have gone out of business, while others, including major providers like United and Cigna, are considering no longer offering plans on the exchange. 

The underperformance of the ACA over the past few years has had repercussions for both Americans looking for affordable health care coverage and companies that need to meet profit margins in order to maintain operations. Legislators will have to revisit the law to ensure its sustainability for all parties involved.—Katie Grosso

Reference: Blaise B. Obamacare's very disappointing 2016 enrollment period. Forbes. February 5, 2016.