In a Hollywood screenplay, the second act starts when the protagonist leaves her home and life behind and sets out on the journey that will define the story. Think of Dorothy being swept from her home in Kansas by the tornado in The Wizard of Oz, or Luke Skywalker escaping from Mos Eisley in Star Wars, or Neo choosing to take the red pill in The Matrix. The second act marks the point of no return—and the point at which the real problems begin in earnest.

This is the point at which Obamacare exists today.

As the third annual open enrollment season begins this week, the law is firmly entrenched in American life and politics. Health coverage rates have increased noticeably in the years since the law went into effect, and millions of people rely on it, in some form or fashion, for insurance. Full repeal at this point is at most a distant possibility, one that can only be imagined over the horizon of next year’s election, if at all. Some of the law’s critics are quietly coming to the conclusion that repeal may now be impossible.

Yet the law is now struggling to stay afloat, to survive and thrive on its terms.

Problem number one for Obamacare is enrollment. The law has consistently undershot its targets. The Department of Health and Human Services (HHS) expects only about 10 million people to sign up for plans the coming year—barely more than the initial expectation for last year, far short of the more than 20 million the Congressional Budget Office (CBO) originally predicted for 2016. It’s possible that HHS is lowballing the estimate, yet if sign-ups outpace expectations by a million or more, the tally will still be far lower than the CBO estimated. Even with the help of the law’s mandate to buy insurance, the federal government is having a difficult time convincing people to sign up.

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