Either the private insurance enrollments come up somewhere around the expected amount or there's going to be a problem. … You need a volume and you need a mix of people that are healthy as well as high users in private insurance, in order to have it be sustainable. —Gail Wilensky
The bulk of enrollment in Obamacare so far has been in Medicaid, free coverage for the very poor, leaving some experts wondering if the imbalance will destabilize the program with too few healthy, paying people in the risk pool.
CBS News reports that "in Washington, of the more than 35,000 people newly enrolled, 87 percent signed up for Medicaid. In Kentucky, out of 26,000 new enrollments, 82 percent are in Medicaid. And in New York, of 37,000 enrollments, Medicaid accounts for 64 percent. And there are similar stories across the country in nearly half of the states that run their own exchanges."
Gail Wilensky, a former Medicaid director, told CBS that the imbalance is grounds for concern.
"Either the private insurance enrollments come up somewhere around the expected amount or there's going to be a problem. You need a volume and you need a mix of people that are healthy as well as high users in private insurance, in order to have it be sustainable," she said.
Setting aside the stability of the insurance pool, Politico reports that the huge influx of Medicaid applicants could create headaches, with more technical glitches and delays.
“We’re flying blind on what the process is,” Kathleen Nolan, state policy head of the National Association of Medicaid Directors, told Politico. “There hasn’t been the capacity to do a lot of the testing. There’s a natural concern that with a major load of data to be sent all at once — there is concern that what has been tested may not be able to handle the volume.”
Among paying customers, the demographic mix is critical, Robert Zirkelbach, spokesman for America's Health Insurance Plans, the association that represents U.S. health insurers, told NPR.
"It's not simply the absolute number of people that are covered that's ultimately going to determine whether coverage is affordable," he says. "It's the type of people that decide to purchase."
"In fact," NPR concluded, "to keep the premiums low and make the system work financially, the government estimates that 40 percent of those 7 million people projected to sign up in the first year need to be young and healthy."