Controversial Obamacare element activated as open enrollment commences

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The Affordable Care Act is facing a huge test.

Tuesday marks the start of open enrollment for the 2017 plan year of the ACA's public exchanges. That's the part of the law, better known as Obamacare, that is designed to give people access to health insurance if they can't access it through their employer or the government.

After news of rising premiums, the withdrawal of several insurance companies, and the US campaign season, we'll finally get a chance to see how healthy the public exchanges — the most talked-about part of the law — really are.

Related: Obamacare protestors

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WASHINGTON, DC - MARCH 04: Ryan Burrows, right, protests with others that are not in support of the portions of the Affordable Care Act on which the Supreme Court of the United States was hearing arguments on Wednesday March 04, 2015 in Washington, DC. (Photo by Matt McClain/ The Washington Post via Getty Images)
Protestors hold placards challenging 'Obamacare' outside of the US Supreme Court on March 4, 2015 in Washington, DC. The US Supreme Court heard a second challenge to US President Barack Obama's Affordable Care Act. The US Supreme Court faces a momentous case Wednesday on the sweeping health insurance reform law that President Barack Obama wants to leave as part of his legacy. The question before the court is whether the seven million people or more who subscribed via the government's website can obtain tax subsidies that make the coverage affordable. A ruling is expected in June. AFP PHOTO/MANDEL NGAN (Photo credit should read MANDEL NGAN/AFP/Getty Images)
Protestors hold placards challenging 'Obamacare' outside of the US Supreme Court on March 4, 2015 in Washington, DC. The US Supreme Court faces a momentous case Wednesday on the sweeping health insurance reform law that President Barack Obama wants to leave as part of his legacy. The question before the court is whether the seven million people or more who subscribed via the government's website can obtain tax subsidies that make the coverage affordable. A ruling is expected in June. AFP PHOTO/MANDEL NGAN (Photo credit should read MANDEL NGAN/AFP/Getty Images)
Demonstrators from Doctors for America in support of U.S. President Barack Obama's health-care law, Obamacare, hold signs while marching in front of the U.S. Supreme Court in Washington, D.C., U.S., on Wednesday, March 4, 2015. A U.S. Supreme Court argument over Obamacare's tax subsidies divided the justices along ideological lines, potentially leaving two pivotal justices to decide the law's fate. Photographer: Andrew Harrer/Bloomberg via Getty Images
Anna Salerno holds a sign and waits with other protestors for President Barack Obama to arrive at the Temple Emanu-El in Dallas, Wednesday, Nov. 6, 2013. President Obama is visiting the charity to thank local volunteers that are working to sign people up for the health insurance under the Affordable Care Act. (AP Photo/LM Otero)
Anti-abortion demonstrators hold signs during a Priests for Life protest outside the US Court of Appeals for the DC Circuit Court as the Court hears the oral arguments in the 'Priests for Life v. US Department of Health and Human Services (HHS)' case in Washington, DC, on May 8, 2014. The case centers around the HHS mandate in the Affordable Care Act, known as Obamacare, that religious organizations must cover contraceptions and abortion as part of their health insurance benefits, even if that goes against the organization's religious beliefs. AFP PHOTO / Saul LOEB (Photo credit should read SAUL LOEB/AFP/Getty Images)
Anti-abortion demonstrators hold signs during a Priests for Life protest outside the US Court of Appeals for the DC Circuit Court as the Court hears the oral arguments in the 'Priests for Life v. US Department of Health and Human Services (HHS)' case in Washington, DC, on May 8, 2014. The case centers around the HHS mandate in the Affordable Care Act, known as Obamacare, that religious organizations must cover contraceptions and abortion as part of their health insurance benefits, even if that goes against the organization's religious beliefs. AFP PHOTO / Saul LOEB (Photo credit should read SAUL LOEB/AFP/Getty Images)
Anti-abortion demonstrators hold signs during a Priests for Life protest outside the US Court of Appeals for the DC Circuit Court as the Court hears the oral arguments in the 'Priests for Life v. US Department of Health and Human Services (HHS)' case in Washington, DC, on May 8, 2014. The case centers around the HHS mandate in the Affordable Care Act, known as Obamacare, that religious organizations must cover contraceptions and abortion as part of their health insurance benefits, even if that goes against the organization's religious beliefs. AFP PHOTO / Saul LOEB (Photo credit should read SAUL LOEB/AFP/Getty Images)
Anti-abortion demonstrators hold signs stating they regret their abortions during a Priests for Life protest outside the US Court of Appeals for the DC Circuit Court as the Court hears the oral arguments in the 'Priests for Life v. US Department of Health and Human Services (HHS)' case in Washington, DC, on May 8, 2014. The case centers around the HHS mandate in the Affordable Care Act, known as Obamacare, that religious organizations must cover contraceptions and abortion as part of their health insurance benefits, even if that goes against the organization's religious beliefs. AFP PHOTO / Saul LOEB (Photo credit should read SAUL LOEB/AFP/Getty Images)
DORAL, FL - APRIL 23: Joyce Zaritsky, Bob Williams, Serena Perez and Mayte Canino (L-R) show their support for the Affordable Care Act in front of the office of U.S. Rep. Mario Diaz-Balart and Sen. Marco Rubio (R-FL) on April 23, 2014 in Doral, Florida. The protesters wanted to ask the politicians if they still want to repeal their constituents health care now that more than 8 million Americans have signed up for health insurance under the Affordable Care Act. (Photo by Joe Raedle/Getty Images)
A demonstrator in support of U.S. President Barack Obama's health-care law contraception requirement holds up a sign outside the U.S. Supreme Court in Washington, D.C., U.S., on Tuesday, March 25, 2014. Hobby Lobby, a family-owned business that says it looks to the Bible for guidance, is seeking a religious exemption from the requirement that employers cover birth control as part of worker-insurance plans. Photographer: Andrew Harrer/Bloomberg via Getty Images
A demonstrator in support of U.S. President Barack Obama's health-care law contraception requirement holds up a sign outside the U.S. Supreme Court in Washington, D.C., U.S., on Tuesday, March 25, 2014. Hobby Lobby, a family-owned business that says it looks to the Bible for guidance, is seeking a religious exemption from the requirement that employers cover birth control as part of worker-insurance plans. Photographer: Andrew Harrer/Bloomberg via Getty Images
Demonstrators in support of U.S. President Barack Obama's health-care law contraception requirement hold up a sign outside the U.S. Supreme Court in Washington, D.C., U.S., on Tuesday, March 25, 2014. Hobby Lobby, a family-owned business that says it looks to the Bible for guidance, is seeking a religious exemption from the requirement that employers cover birth control as part of worker-insurance plans. Photographer: Andrew Harrer/Bloomberg via Getty Images
Demonstrator Alan Hoyle holds a bible as he stands outside the U.S. Supreme Court in Washington, D.C., U.S., on Tuesday, March 25, 2014. Hobby Lobby, a family-owned business that says it looks to the Bible for guidance, is seeking a religious exemption from the requirement that employers cover birth control as part of worker-insurance plans. Photographer: Andrew Harrer/Bloomberg via Getty Images
Demonstrators in support of U.S. President Barack Obama's health-care law contraception requirement hold up signs outside the U.S. Supreme Court in Washington, D.C., U.S., on Tuesday, March 25, 2014. Hobby Lobby, a family-owned business that says it looks to the Bible for guidance, is seeking a religious exemption from the requirement that employers cover birth control as part of worker-insurance plans. Photographer: Andrew Harrer/Bloomberg via Getty Images
Demonstrators opposed to U.S. President Barack Obama's health-care law contraception requirement hold up signs outside the U.S. Supreme Court in Washington, D.C., U.S., on Tuesday, March 25, 2014. Hobby Lobby, a family-owned business that says it looks to the Bible for guidance, is seeking a religious exemption from the requirement that employers cover birth control as part of worker-insurance plans. Photographer: Andrew Harrer/Bloomberg via Getty Images
Demonstrators opposed to U.S. President Barack Obama's health-care law contraception requirement hold up signs outside the U.S. Supreme Court in Washington, D.C., U.S., on Tuesday, March 25, 2014. Hobby Lobby, a family-owned business that says it looks to the Bible for guidance, is seeking a religious exemption from the requirement that employers cover birth control as part of worker-insurance plans. Photographer: Andrew Harrer/Bloomberg via Getty Images
Demonstrators in support of U.S. President Barack Obama's health-care law contraception requirement hold a sign outside the U.S. Supreme Court in Washington, D.C., U.S., on Tuesday, March 25, 2014. Hobby Lobby, a family-owned business that says it looks to the Bible for guidance, is seeking a religious exemption from the requirement that employers cover birth control as part of worker-insurance plans. Photographer: Andrew Harrer/Bloomberg via Getty Images
MIAMI, FL - SEPTEMBER 20: Deborah Dion (L), Hattie Coleman and other protesters gather in the office of Florida State Rep. Manny Diaz as they protest his stance against the expansion of healthcare coverage on September 20, 2013 in Miami, Florida. As the protest took place, the Republican led House in Washington, D.C. by a 230-189 tally passed a short-term government spending plan that would eliminate all funding for 'Obamacare.' The Florida State government is also working against the Affordable Care Act by refusing to set up its own health care exchanges and they also have highlighted concerns about the navigators, federally funded workers who will help enroll people in health plans. (Photo by Joe Raedle/Getty Images)
Anti-abortion protesters pray outside the US Supreme Court on the third day of oral arguements over the constitutionality of the Patient Protection and Affordable Care Act on March 28, 2012 in Washington, DC. The 26 states challenging the law argue that Obama's Affordable Care Act must be completely repealed if the requirement that all Americans buy health insurance -- known as the 'individual mandate' -- is found to be unconstitutional. AFP PHOTO/MLADEN ANTONOV (Photo credit should read MLADEN ANTONOV/AFP/Getty Images)
A masked pro-Obamacare demonstrator stands outside the US Supreme Court June 25, 2012, in Washington, DC, as they await the court's ruling on the Healthcare Reform Law. The court announced the decision on healthcare will not happen before June 28. AFP PHOTO/Jim Watson (Photo credit should read JIM WATSON/AFP/GettyImages)
Anti-abortion protesters pray outside the US Supreme Court on the third day of oral arguements over the constitutionality of the Patient Protection and Affordable Care Act on March 28, 2012 in Washington, DC. The 26 states challenging the law argue that Affordable Care Act must be completely repealed if the requirement that all Americans buy health insurance -- known as the 'individual mandate' -- is found to be unconstitutional. AFP PHOTO/MLADEN ANTONOV (Photo credit should read MLADEN ANTONOV/AFP/Getty Images)
UNITED STATES – MARCH 27: Rep. Michele Bachmann, R-Minn., speaks during the Tea Party Patriots rally protesting the Affordable Care Act in front of the Supreme Court as the court hears arguments on the health care reform bill on Tuesday, March 27, 2012. (Photo By Bill Clark/CQ Roll Call)
UNITED STATES – MARCH 27: Tea Party Patriots supporters hold signs protesting the Affordable Care Act in front of the Supreme Court as the court hears arguments on the health care reform bill on Tuesday, March 27, 2012. (Photo By Bill Clark/CQ Roll Call)
Ronald Brock moves his anti-Obamacare sign as protestors, press, and passersby wait for decisions in the final days of the Supreme Court's term, in Washington, Wednesday, June 25, 2014. The court has yet to announce its finding in Sebelius v. Hobby Lobby Stores. The chain of arts-and-crafts stores does not want to provide insurance coverage for certain forms of contraception that it finds objectionable on religious grounds. The justices ruled Wednesday that a startup Internet company has to pay broadcasters when it takes television programs from the airwaves and allows subscribers to watch them on smartphones and other portable devices.The justices said by a 6-3 vote that Aereo Inc. is violating the broadcasters' copyrights by taking the signals for free. (AP Photo/J. Scott Applewhite)
Protestors block traffic near the White House in Washington, Thursday, June 5, 2014. In response to President Obama’s decision to delay the deportation review he ordered from the Department of Homeland Security, United We Dream protested near the White House to highlight the urgency of the administration acting now. (AP Photo/Susan Walsh)
Carlos Padilla of Seattle, Wash., holding flags, and other protestors block traffic near the White House in Washington, Thursday, June 5, 2014. In response to President Obama’s decision to delay the deportation review he ordered from the Department of Homeland Security, United We Dream protested near the White House to highlight the urgency of the administration acting now. (AP Photo/Susan Walsh)
Demonstrators display signs during a protest on West Florissant Avenue in Ferguson, Missouri on August 18, 2014. Police fired tear gas in another night of unrest in a Missouri town where a white police officer shot and killed an unarmed black teenager, just hours after President Barack Obama called for calm. AFP PHOTO / Michael B. Thomas (Photo credit should read Michael B. Thomas/AFP/Getty Images)
Pakistan protesters from the Jamaat-e-Islami party gather around a protester dressed as US President Barack Obama effigy during a pro-Palestinian demonstration against Israel's military campaign in Gaza, in Karachi on August 17, 2014. Indirect talks between Israelis and Palestinians for a long-term truce in Gaza resumed on August 17, 2014, with just over a day left before a temporary ceasefire is set to expire, a Palestinian official said. AFP PHOTO/Rizwan TABASSUM (Photo credit should read RIZWAN TABASSUM/AFP/Getty Images)
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After all the negative headlines, it appears that this open-enrollment period is especially important for the future of one of President Barack Obama's signature achievements.

How we got here

The ACA doesn't exclusively pertain to the exchanges. There are other elements of the law that affect all Americans, such as a child's ability to stay on his or her parent's insurance until they're 26 years old and the removal of lifetime limits on insurance payouts.

For better or for worse, the sustainability of the exchanges is probably the most often used benchmark for people judging its success or failure, despite the fact that only roughly 5% of Americans get their insurance through the exchanges.

The problems with the Obamacare exchanges are now well documented. Fewer healthy people have signed up for the plans, and that has caused the pool of people in the exchanges to be older, sicker, and more expensive to cover. That's led to losses for many insurers.

Some of the biggest and most high profile of these insurers — such as Aetna andUnitedHealthcare and startup Oscar — have pulled back their offerings in these markets. And the exchanges have become political fodder for everyone from Republican Speaker of the House Paul Ryan to presidential nominee Donald Trump. Even former President Bill Clinton has talked about flaws in the marketplace, though he later clarified he supports the ACA.

SEE ALSO: CNN quietly corrects controversial Trump story

The law's supporters say these are growing pains.

"This is one of the most complex social programs in the country's history," Kevin Counihan, the CEO of the Marketplace at the Centers for Medicare and Medicaid Services (CMS) said in an interview with Business Insider. Counihan oversees the exchanges. "We only have three years of operation. Big programs like Social Security and Medicare also had problems in their first three years."

Counihan said that many insurance companies are not used to these types of markets, which are more like "Medicaid-plus" than the employer-based market so a "learning curve" isn't surprising.

SEE ALSO: Obamas celebrate final Halloween at the White House

Make or break year

The Department of Health and Human Services (HHS), which is responsible for administering the law, projects that 13.8 million Americans will sign up or continue to get coverage through the exchanges in 2017, up from 12.7 million last year.

The 2017 enrollment also features massive jump in the average premium cost from last year — the HHS projects it to be 25% for the baseline silver-level plan for the country. These jumps are even more severe in certain states, with Arizona leading the way with a 116% increase over the average premium in 2016.

According to Cynthia Cox, associate director for the Program for the Study of Health Reform and Private Insurance at the nonpartisan research group Kaiser Family Foundation, these price increases and market shifts have been coming for some time.

"The premium increases were something we were expecting," Cox told Business Insider. "They're a bit higher than we thought they would be, but insurers have been signaling for months that this year they needed to dramatically increase premiums to make up for losses on the exchanges."

Counihan said that these increases came about in part because many insurers did not have experience with the type of coverage needed for Obamacare, so they underpriced their plans to attract patients without properly rating the costs.

Additionally, the jump now brings premiums roughly in line with the nonpartisan Congressional Budget Office's original 2010 projection for premiums on the exchanges for 2017.

This year is also more important because this is the first time the exchanges will be without their "training wheels." Insurers previously had three different ways provided by the government to mitigate losses from the exchanges: reinsurance, risk corridors, and risk adjustment. Now that is being shaved down to only the risk-adjustment program.

Related: 44 iconic photos of Barack Obama's presidency

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44 iconic photos of Barack Obama's presidency
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44 iconic photos of Barack Obama's presidency

Barack Obama takes a moment to reflect before walking on stage to take the oath of office.

Photo Credit: The White House

Barack Obama and the First Lady share a tender moment during the Inaugural Ball on Jan. 20, 2009. 

Photo Credit: The White House

Obama enters the Oval Office on the first day of his presidency. 

Photo Credit: The White House

President Obama reads a letter left in his desk by George W. Bush, a White House tradition welcoming the new President. 

Photo Credit: The White House

Obama tours the grounds of his new home for the next 8 years. 

Photo Credit: The White House

Barack Obama meets with senior advisors in his third week as president.

Photo Credit: The White House

President Obama settles in for his first flight aboard Air Force One. 

Photo Credit: The White House

The 44th President of the United States gives his first State of the Union address on February 24, 2009. 

Photo Credit: The White House

Mr. & Mrs. Obama walk hand in hand towards the helicopter that will take them on their first trip to Camp David. 

Photo Credit: The White House

Michelle Obama shakes hands with Queen Elizabeth at the Buckingham palace during their trip for the G20 summit.

Photo Credit: The White House

POTUS shows some love for his troops while visiting Camp Victory in Iraq on April 7, 2009. 

Photo Credit: The White House

The Obamas share a laugh while eating a snack after an event. 

Photo Credit: The White House 

Obama and Biden take in some fresh air with some golf on the White House green.

Photo Credit: The White House

President Obama explores the Pyramids of Giza during a trip to Egypt on June 4, 2009. 

Photo Credit: The White House

POTUS walks through his first G8 Summit in Italy. 

Photo Credit: The White House

Barack Obama takes in the beauty of the Grand Canyon.

Photo Credit: The White House

President Obama enjoys himself during an interview with David Letterman on Sept 21, 2009. 

Photo Credit: The White House

The Obama's welcome children to enjoy Halloween fun at the White House. 

Photo Credit: The White House

President Obama accepts his Nobel Peace Prize for "extraordinary efforts to strengthen international diplomacy and cooperation between peoples".

Photo credit: AP Photo/John McConnico

President Obama and the First Lady take their first portrait in front of the official White House Christmas tree. 

Obama sits in his personalized chair during a meeting. 

Photo Credit: The White House

The Obama's bust a move during the Governors' Ball. 

Photo Credit: The White House

Obama takes a moment to catch up on some important documents while on the go. 

Photo credit: The White House

The President takes calls at all hours leading up to the vote on healthcare reform.

Photo credit: The White House

Obama and Biden applaud the passing of the Affordable Care Act.

Photo Credit: The White House

White House Photographer Pete Souza had this to say about capturing this photo: "The sun was setting as the Presidential motorcade arrived back at Miami International Airport. I ran to get in front of Air Force One so I could use the beautiful sky as the background when the President boarded the plane."

Photo Credit: The White House

The Obamas lip-sync to a group of a cappella singers during a holiday visit. 

Photo Credit: The White House

A rare moment in the Situation Room of the White House.

Photo Credit: The White House

The President greets soldiers after a surprise all night flight to Afghanistan. 

Photo Credit: The White House

The Obama family admires Rio's infamous Christ the Redeemer statue while In Brazil on March 20, 2011. 

Photo Credit: The White House

Barack Obama approaches the Marine One helicopter. 

Photo Credit: The White House

President Obama watches the screen like a hawk during the real time mission to capture Osama bin Laden.

Photo Credit: The White House

The White House photographer Pete Souza writes "The President was ready to announce the news about the mission against Osama bin Laden and was putting the finishing touches on his statement in the Outer Oval Office. As he did so, the networks broke in with bulletins confirming that bin Laden had been killed and a photograph of him appeared on the television screen in the background near the Vice President and Press Secretary Jay Carney."

Photo Credit: The White House

Souza says "One of the most memorable moments of the year was when the President hugged Rep. Gabrielle Giffords as he walked onto the floor of the House Chamber at the U.S. Capitol to deliver his annual State of the Union address."

Photo Credit: The White House

Pete Souza reveals an interesting fact about this photo: "The President hugs the First Lady after she had introduced him at a campaign event in Davenport, Iowa. The campaign tweeted a similar photo from the campaign photographer on election night and a lot of people thought it was taken on election day."

Photo Credit: The White House

Basketball fans cheer for the Obamas as they kiss for the kiss cam. 

Photo Credit: The White House

President Obama serenades Michelle on her birthday. 

Photo Credit: Pete Souza

President Obama sits for a 3D portrait at the Smithsonian.

Photo Credit: The White House

President Obama takes a detour after the NATO summit to visit Stonehenge. 

Photo Credit: The White House

Barack Obama can't keep a straight face while recording a Holiday video at the White House. 

Photo Credit: The White House

Mr. President speaks at the 50th Anniversary of Bloody Sunday and the Selma to Montgomery civil-rights marches.

Photo Credit: The White House

President Barack Obama and President Raúl Castro of Cuba shake hands during the Summit of the Americas at the Atlapa Convention Center in Panama City, Panama on  April 11, 2015.

Photo Credit: The White House

President Obama stands at attention while Vice President Biden announces he will not be running for President.

Photo credit: AP Photo/Jacquelyn Martin

U.S. President Barack Obama collects the folio holding the Bipartisan Budget Act of 2015 after signing it into law in the Oval Office at the White House in Washington, November 2, 2015.

Phto credit: REUTERS/Jonathan Ernst

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Additionally, 2017 will be the first year that the full penalty for not having insurance will go into effect, but the fee will not show up on tax bills until after the open-enrollment period.

Counihan downplayed the idea that this is a pivotal year for the exchanges, saying that it is a "retooling year." Additionally, Counihan said the HHS and CMS has plans to make sure it meets its targets and grows the exchanges, including outreach targeted at young people who would help stabilize the risk pools.

"We have a lot of data and good outreach plans for this year to get all kinds of people to sign up," said Counihan. "I mean, we know what we're doing — we're not just throwing darts and hoping it hits."

The real figure of success, Cox said, will be if the exchanges can sustain the number they have now.

"If we start to see sign-ups decrease, that would raise a lot of questions about the long-term sustainability of the exchanges," Cox said. "If people are deciding to leave the exchanges, that could lead to more insurer exits and be a real problem."

That may be a low bar to clear, but given the negativity surrounding the exchanges for much of the past six months, perhaps no bad news is good news.

Related: Twitter reactions to Obamacare held up by Supreme Court

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Twitter reactions to Obamacare held up by Supreme Court
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Twitter reactions to Obamacare held up by Supreme Court
Americans deserve better than what we’re getting with Obamacare. It’s time we repealed and replaced it! http://t.co/1EHfbVKBMa
I applaud #SCOTUS' decision to uphold #ACA. Our people, communities & economy are stronger when healthcare is affordable and accessible.
We need Consumer Care, not ObamaCare.
I believe SCOTUS wrongly decided to approve @POTUS's unlawful implementation of Obamacare. READ my statement: http://t.co/6n9gC3bwx3
Yes! SCOTUS affirms what we know is true in our hearts & under the law: Health insurance should be affordable & available to all. -H
TY #SCOTUS for reaffirming what health law is about: helping families purchase affordable health insurance. #ACAworks http://t.co/m3dRSGpzRx
Problems w/ Obamacare run deeper than just drafting errors, & Oklahomans shouldn’t pay the price for regulators run amok. #KingvBurwell
With #SCOTUS #KingvBurwell ruling, now we can focus on providing health care, rather than litigating it → http://t.co/n0J6VnCXG9
This decision turns both the rule of law and common sense on its head. #KingvBurwell
I hope that w/ today’s decision, we can work together to move health care forward, not backward, for families we serve. -PM #KingVBurwell
Big win in today's #KingvBurwell decision. Now nearly 160k Hoosiers including 20k in the 7th District can keep their current healthcare
Celebrating this huge victory for affordable healthcare from #SCOTUS! #ACA http://t.co/BA0MKg6POF
BREAKING: #SCOTUS just upheld Affordable Care Act 6-3. Great news for 6.4 million Americans.
Oh please...brave souls in GOP Leadership thought #SCOTUS wd save them from actually having to DO THEIR JOBS. https://t.co/ntBvztFbI4
#SCOTUS ruling to uphold #ACA subsidies is right decision, not only for the law, but for our millions of families receiving these subsidies.
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The future is uncertain

The real proof of the success or failure of the law likely won't come from the sign-up numbers alone, according to Cox. Instead, the real tell will be the proposals for 2018 premiums that the health-insurance companies have to submit to individual state regulators in the spring of 2017.

"That's really when we'll know whether this was just a one-year change or something larger and longer-lasting," Cox added. "If premiums rise significantly again and you start to see more providers leaving the exchanges, that will raise a lot of long-term questions."

As Aetna CEO Mark Bertolini put it in an interview with Bloomberg, this could lead to a constant chase of healthy people opting out of the exchanges because of high costs, which in turn leads to higher premiums to cover the ever-sicker pool in the exchanges.

"So what happens is the population gets sicker and sicker and sicker and sicker, the rates get higher to try and catch it — it's a fruitless chase, and ultimately you end up with a very bad pool of risk," said Bertolini.

So with a very bad pool of risk, more insurers dump their exchange business until it becomes unsustainable.

Given these issues, most people agree that the law could use some tweaks. Even Obama said that the law was like a new phone that rolls out with "a few bugs" and needs to be updated to stabilize it.

SEE ALSO: White House: FBI director 'is in a tough spot,' Obama doesn't believe he's trying to influence election

There have been several proposals, mostly split on ideological lines. Mostly conservative detractors of the law have suggested repealing the ACA altogether, while on the other end of the spectrum observers have used the shortcomings to call for a nationalized health system. In the middle, there proposals include adjusting a rule that only allows insurers to charge older people three times what they charge young people, strengthening the tax on people without insurance, and more variety instead of sticking with the four-tiered system in place now.

According to Cox, pretty much any of these adjustments would help fix the issues the Obamacare exchanges are facing.

"Any or all of these changes could have the effect of stabilizing the marketplace," Cold told us. "Also, they don't have to be done in isolation — any number of them could be used in combination to address the challenges facing the market."

The problem is that all these changes can be enacted only if Congress passes a law amending the ACA.

"The HHS and CMS are really limited in what they can do now to address these issues," said Cox.

In the end, however, most of the changes come down to a political vote and given the current make-up of Washington, it is unlikely anything comes to fruition. Counihan even called it a "less than helpful political environment."

Cox agreed that much of the law's long-term survival has little to do with its impact on healthcare, but rather the political appetite for the law.

Regardless of possible changes, Counihan said that the law has earned a permanent place in the health care system of America (though he is admittedly biased).

Cox, on the other hand, said that the ACA and its exchanges have certainly made an impact, but whether or not they survive remains to be seen.

"It depends on politics and market stability," said Cox. "It's equally, if not more, important how Americans perceive the law, and right now they're pretty split."

Based on Kaiser's polling, 45% of Americans have a favorable view of the ACA and 45% have an unfavorable view.

Open enrollment closes January 31.

More from Business Insider:

Donald Trump is going scorched earth on Obamacare in a last-ditch campaign effort
Here's how much Obamacare premiums are going up in every state
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