An Associated Press article delves into the question of whether the Affordable Care Act’s historic gains in coverage  through ACA health-insurance exchanges may be losing steam now that the Obama administration says that it expects only a slight increase in enrollment next year.

Health and Human Services Secretary Sylvia M. Burwell set a target of 10 million people enrolled and paying their premiums by the end of next year.  “That’s about as many as are covered now through the law’s online markets for subsidized private health insurance,” the AP wrote.

“Ms. Burwell said it’s getting harder to sign up the remaining uninsured. They tend to be young, managing very tight household budgets, and often unaware they can qualify for taxpayer-financed assistance with their premiums.”

“If enrollment plateaus, we may see growing discussion of whether the law is fulfilling expectations in covering the uninsured, and whether the subsidies for low- and middle-income people are sufficient to make coverage truly affordable,” said Larry Levitt, an expert on the law with the nonpartisan Kaiser Family Foundation, told the news service.

Among the problems the AP discusses are the law’s complexity, out-of-pocket costs and high turnover.

To elaborate on the turnover problem:

“Some people who sign up for a plan don’t follow through and pay their first month’s premiums. Among those who do obtain coverage, some later switch to an employer plan or qualify for Medicaid. Others drop out because they can’t afford even their subsidized premiums.”