The Affordable Care Act has accurately been described as a wealth transfer from the young and healthy to the older and less healthy population. However, this cross-subsidy in turn relies on conformity of the younger population to participate in the exchanges. According to this article, the regulation needs 2.7 million young, healthy participants out of the total 7 million expected in order to sustain the program. If this does not happen, insurers will lose money, be forced to increase premiums in compliance with other new coverage regulations, and this could exacerbate the problem.
An issue that's been widely covered the past couple of weeks is the failure of the new ACA website to enroll people in the exchanges. It is a very complicated system, and many people have attempted and failed to enroll on the website multiple times due to bugs and data extraction problems. Performing all the steps required to enroll in the exchanges takes a lot of time, especially given the issues with the website. Some economists and commentators worry that this could lead to an adverse selection problem. The people earning the subsidies (those who are elderly and sick) will be more likely to work through the issues with the website and costly application process, while the young and healthy will be less likely to bear the transaction costs associated with the exchanges, opting to take the $95 (or 1% of income) tax penalty. This could lead to the aforementioned problem, which is now known as the "death spiral". The issues with the website and nature of the tax penalty seem to incentivize an outcome with fewer young, healthy people than needed to sustain the program.
The threat of the death spiral shows that conformity with collective action should not be taken for granted, and I believe the existence of the death spiral is a testament of the inability of politicians to recognize the importance of incentives in achieving desired outcomes.
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