The Campaign Spot

Hello, Death Spiral.

At first, it sounds good that 2.2 million Americans signed up for private health insurance through the federal and state exchanges from October 1 to December 28.

But the administration’s goal was a bit more than 7 million by the end of March. So half of the signup period has passed, and they’re at 31 percent of their goal. Much better than October and November, obviously, but still considerably behind. (Recall that December was expected to see a bump because of the deadline to have coverage begin January 1.)

And in an ominous sign for those who worry about a “death spiral” of older, sicker pools of enrollees driving up costs and premiums, about 55 percent of the early enrollees are between the ages of 45 and 64.” Just 24 percent are 18 to 34 years old. So the young invincibles aren’t signing up in the numbers that insurance companies need.

You’ll hear HHS Secretary Kathleen Sebelius lump in the roughly 4 million who have been added to the Medicaid rolls, but that doesn’t do much for the insurance companies, as most Medicaid recipients don’t pay for their care other than some minimal copays.

Above: the health-insurance market death spiral, as seen from space.

(No, not really. It’s from the old “Spiral Zone” cartoon.)