Insurance market reform the grand experiment.

There are concerns that guaranteed issue and community rating provisions within the Affordable Care Act (ACA) could trigger a "death spiral"-a phenomenon in which community rating compressed rates make it more expensive for the relatively young and healthy to obtain coverage. A recent analysis by Milliman suggests these concerns may be overblown, but some form of significant disruption remains a distinct possibility, given a relatively weak mandate and meager subsidies for those with incomes starting around 250 percent of the federal poverty limit. Whatever the outcome, these ACA provisions will make it necessary for hospitals and health systems to take significant steps to control costs.