Is Obamacare dying?

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Sean Jackson, like tens of thousands of other Americans, has had trouble signing up for medical coverage using the insurance marketplace, despite several attempts.

“I was able to create an account on Oct. 2, and I haven’t been able to get into there since,” said Mr. Jackson, a sports journalist living in Ohio, a note of annoyance in his voice. “I’ll try at random times, like late at night or early in the morning. I sign in. It just goes to a blank screen.”

The economists and policy wonks behind the Affordable Care Act worry that the technical problems bedeviling the federal portal could become much more than an inconvenience. If applicants like Mr. Jackson decide to put off or give up on buying coverage, rising prices and even a destabilized insurance market could result.

The enrollment of people like Mr. Jackson, who is 32, is vital for the health care law — and, for that matter, the entire health care system — to work.

Younger people, who tend to have very low anticipated medical costs, are supposed to help pay for the medical costs of older or sicker enrollees.

Without them, so-called risk pools in Ohio and other states might become too risky, forcing insurers to raise premiums.

Those higher premiums could dissuade more of the young and healthy from signing up, forcing insurers to raise prices again.

Economists call the process “adverse selection” and warn that in its worst iteration it could lead to a “death spiral” of falling enrollment and climbing prices.

Economists and health analysts said the chances of such a spiral were slim in most states because Americans who go without insurance would face penalties, starting next year. But they said that the endemic problems with the Web site posed a serious question about the enrollment balance in many state plans.

“If there are significantly more of the older and higher-cost people purchasing coverage than are expected, that’s going to have a significant impact on premiums for the following year,” said Robert Zirkelbach, a spokesman for America’s Health Insurance Plans, a lobbying group for insurers covering 200 million Americans. He added, “It could ultimately destabilize the market.”

The young and healthy have always been seen as crucial to making the health law work, and the Obama administration and many state governments have focused on getting them to sign up.

For the White House, that has meant using the demographic microtargeting techniques used during the 2008 and 2012 presidential campaigns to identify and reach young people in the hope that they would make up about 40 percent of new enrollees in the health exchanges.

For Colorado, it has meant creating an advertisement showing “bros” drinking beer while celebrating insurance coverage. “Keg stands are crazy,” the ad reads. “Not having health insurance is crazier.”

But getting “young invincibles,” as insurers sometimes call them, to sign up for insurance is an uphill climb.

Even with the public campaigns, only about one in four 19- to 29-year-olds is even aware of the exchanges where they might buy affordable insurance, and the ignorance is especially acute among the uninsured, according to a survey this year by the Commonwealth Fund, a nonprofit research group.