The ACA guarantees issue of individual and small group health insurance at premiums that do not consider a buyer’s health during annual open enrollment and special enrollment periods. Individual market enrollment has been much lower than projected; the average age and morbidity of enrollees has been higher. The 3 to 1 age rating band lowers premiums for older buyers but increases premiums for younger people, reducing their incentives to insure. People who failed to obtain and/or maintain coverage would not be guaranteed access to coverage at rates that do not reflect their health status. That state experience, however, arose without either refundable tax credits to encourage coverage take up or separately funded high risk pools.

Source: Forbes January 28, 2017 16:18 UTC