I wonder if the healthcare spending that they assumed would occur due to the Affordable Care Act didn't occur because of logistical problems? I had a conversation with someone that works in finance at an insurance provider and they let me know that it's been very difficult getting the enrollees to pay once they are part of the exchange. This isn't necessarily because these people don't want to pay, it's largely because the account set-up was so bad on the govt side that the insurance providers are having a difficult time syncing up the healthcare recipient with their ACA account. Key data points like name, dob etc will be wrong or different. For example, instead of Michael, they wrote "mike," things like that. This prevents a quick reconciliation and participants aren't officially a part of the exchange until they make their first payment. It sounds like a big problem.