Only an older, sicker and more expensive population have signed up during the first month the Affordable Care Act exchanges have been “open.” From the Wall Street Journal:

Insurers say the early buyers of health coverage on the nation’s troubled new websites are older than expected so far, raising early concerns about the economics of the insurance marketplaces.

If the trend continues, an older, more expensive set of customers could drive up prices for everyone, the insurers say, by forcing them to spread their costs around. “We need a broad range of people to make this work, and we’re not seeing that right now,” said Heather Thiltgen of Medical Mutual of Ohio, the state’s largest insurer by individual customers. “We’re seeing the population skewing older.”

This is not surprising. It was always assumed people with health problems would be the most eager to check out the exchanges. Combined with the technically difficulties of signing up, it is predictable that only people who really need insurance would put up with the hassle to complete the process.

This will not be a long term problem if the exchanges are fixed soon. Most people have probably not even tried to sign up yet because it is still early. We will probably see two big waves. The most important will be at the beginning of December, which is the deadline to get coverage by January. The second will be the end of the open enrollment period in late March. People tend to wait until the last minute.

If the exchanges are not fixed on time, though, this will be a real political and policy problem for the backers of the law. For now it is just a warning sign.

Photo courtesy Boston Public Library under Creative Commons license