WELL, YES: Obamacare Exchanges Were in Big Trouble Before Trump.

As many readers will recall, 2016 brought hefty premium hikes to make up for years of losses on the exchanges. Going into this year’s open enrollment period, there seemed to be a significant risk that we’d see what economists call “adverse selection”: People who were getting good value out of their insurance (because they used a lot of services) would keep paying the premiums, even if they grumbled a bit, but people who didn’t use a lot of health care would decide that at those prices, they might as well go uninsured. When those people exited the market, the average cost to cover each person remaining in the pool would be higher … and insurers still wouldn’t make money, forcing them to raise premiums again next year. This process is known as the “adverse selection death spiral.”

December’s numbers seemed to indicate that people were still willing to buy insurance at the new, higher prices. January’s numbers suggest that maybe they aren’t. Most worryingly, young people, who don’t worry that much about the health insurance they rarely use, tend to sign up fairly late in the game, so a rise in December and a decline in January means that the pool could end up substantially older and sicker than last year’s.

That has been the trend from the start.

And:

You can argue that the problem was not the advertising, but the fact that the Trump administration was obviously against Obamacare. And I suppose that’s possible — except that Trump won in November, so how come people only reacted in late January? It’s not as if it was exactly a secret that Republicans wanted to repeal the thing. Nor do I find it plausible that potential customers were following the play-by-play of fiddling changes to health care policy during the last 10 days of the month — in part because the news was completely dominated by other things, but mostly because I’ve never seen evidence that these consumers were following this sort of deep-in-the-weeds wonkplay at any time in the history of the program.

Besides, there’s another mechanism that’s just as plausible: Young and healthy people tend to sign up late, and young and healthy people are the ones who are most likely to have balked at higher premiums.

The ObamaCare exchanges are a great deal for people too old or sick to be insurable anywhere else. For everyone else, not even the certainty of paying a penalty (“It’s a tax!”) and the risk of going without insurance makes them a good deal.

The failure was baked in at the start.