Opponents of Obamacare claim that the Affordable Care Act (ACA) is in a “death spiral,” whereas proponents of the law say otherwise. (here) Speaker of the House Rep. Paul Ryan (R-WI) has repeatedly used the expression over the past few weeks.

The Department of Health and Human Services (HHS) recently released the early number of sign-ups in the federal and state exchanges for 2017. (here) The numbers are slightly higher than last year at the same time. This data encourages proponents of Obamacare to claim no death spiral, simply a leveling-out of the individual health insurance market.

There are several warning signs, however. First of all, insurance premiums in the individual market rose 25 percent on average nationally. With the ACA mandates of guaranteed issue and community rating, premiums for 2018 are very likely to rise by at least the same percent as older, sicker people use the exchanges.

Second, to slow the rise in premiums, younger, healthier individuals must enroll through the exchanges. The HHS data reveal that the number of people 18 to 34 years of age actually dropped from 28 percent in 2016 to 26 percent in 2017. This is a worrisome indicator that older, sicker, and more costly individuals are using the exchanges in 2017. The Obama Administration even admits that to make the exchanges financially solvent, at least 40 percent of enrollees need to be in the 18 to 34 years of age bracket.

Proponents of the law state that ever-rising premiums really don’t matter, because as premiums go up, the amount of taxpayer subsidies go up as well. Of course, from the insurance company’s standpoint, it doesn’t matter who pays the premium. If the aggregate of premiums don’t cover the patient costs, the insurance companies still need to raise their premiums. The alternative, as we have already seen, is for the company to simply leave the market and thereby limit the choices for patients.

The money in Obamacare essentially goes to two places – subsidies in the exchanges and the expansion of Medicaid. Regardless of enrollment numbers, if the medical costs of the patients exceed the amount of money the insurance carriers collect in premiums, the exchanges will spiral out of existence. The expansion of Medicaid would potentially remain. However this entitlement is not financially viable in its present form, especially if the taxes in Obamacare are repealed.

The evidence strongly suggests Obamacare is indeed in a death spiral.