That was the implication of a claim by Bob Laszewski, a health policy analyst, interviewed on Morning Edition. Laszewski told listeners that the problems with the mechanics of the exchanges could be a problem for insurers:

"They're very worried about only sick people showing up for coverage, because only sick people are willing to go through the gauntlet."

If it turns out that the exchanges in the states run by the federal government produce such a serious skewing of applicants that it becomes unprofitable for insurers, then it's possible that these states would end up without insurance provided through the exchanges. This would be an interesting outcome since it would mean that the states that refused to set up their own exchanges will have succeeded in denying their residents of the benefits of the Affordable Care Act. On the other hand, states like California, New York, and Kentucky, which did set up their own exchanges, seem to be signing up people with few problems, so presumably the insurance markets in these states will work as expected.

As a practical matter, it really doesn't matter if the people who sign up in the first few weeks are skewed toward the sicker segment of the population. It will only matter if this continues to be the case through 2014.