ACA for MandM

About 7 million people are expected to buy insurance through the marketplaces in the first year. But it's more important to watch who signs up rather than how many. For these new insurance markets to thrive, they'll need to take in more in premiums then they spend on health care, so they need more healthy buyers than sick, economists say.

We often hear that the administration's first-year objective is to sign-up 7 million people––of which 2.4 million need to be aged 18-34, in order to get a sustainable mix.

But, buyer beware. Consumers need to be very thorough here. A Silver plan is not a Silver plan is not a Silver plan.

he 2015 exchange rates and health plans will have to be developed by the participating insurance companies in mid-2014 so they can go through the approval process and be put on the exchange in time for the next year's October 1 open enrollment

She eventually went to the M. D. Anderson Cancer Center in Houston, where she has been treated for more than two months. The bill at the end of August was $650,000. The hospital, he said, called them to ask for a payment for $500,000.

But while Mr. Cantu expects to enroll for coverage for next year, the law won’t help him with his wife’s medical bills, which he estimates now approach $1 million, if not more. “Where am I going to get that kind of money?” he said. “In 20 years, I wouldn’t be able to pay it off.”

is uncertain financial situation is typical of the population most likely to consider the insurance marketplaces, said Ceci Connolly, managing director of the Health Research Institute at PricewaterhouseCoopers. Only about 51 percent will have full-time jobs, with a median annual income of about $21,700, according to an analysis by her firm based on government data like the census. She said 38 percent of the people expected to enroll will end up shuttling several times between Medicaid and the marketplaces over the next four years. <img src="http://meter-svc.nytimes.com/meter.gif"/>