Few people like to talk about the Affordable Care Act, so we felt it was imperative that you know today is the registration deadline for Obamacare. Just kidding—without a doubt you’ve heard the low numbers of enrollees, delays, a website that failed consistently (including today), and the endless politics around it all. But looking back today on the trajectory of the ACA, what has happened and what does it mean for you and your business?

According to Avalere Health, the national numbers just don’t matter like state numbers do. The high number of enrollees in some states will not outweigh the low numbers in others. And, Ohio is one of those states lagging behind, according to Kaiser Health News. The 10 states lagging, including Ohio, account for 30 million uninsured; in Ohio, only 10% eligible for marketplace insurance have registered.

Looking at the latest Health and Human Services numbers, as of March 11, 78, 925 people have selected a marketplace plan. Of those who have registered, 21% fall in the 18-34 age range, compared to 25% nationally, while 36% are aged 55-64, compared to 30% nationally. In reality, we can see that Ohioans aren’t signing up, not enough young people are participating, and some people generally don’t plan to, penalty or no penalty.

For exchanges to function properly, the 18-34 age group, younger and generally healthier, need to purchase health coverage in order to subsidize those who are older and sicker. If this balance is not struck, some fear the exchanges will enter a so-called “death spiral” where only the older and sicker participate and health care premiums increase significantly as a result, further deterring young people until they are sick and injured, further increasing costs, etc., etc.

Ohio (and the country) are well behind below the 38% goal set by the White House. While a death spiral is unlikely, the fact remains that Ohio is behind and this unbalance could lead to substantial instability in the health care marketplace – another unwelcome potential development for employers already struggling to keep a lid on their health care costs. Along with the multiple delays, including two employer mandate delays, it has become a complicated and unpredictable landscape for businesses.