2014 brings big challenges for Obama's health care law: Circle these dates - Minneapolis Star Tribune

WASHINGTON — The new year brings the big test of President Barack Obama's beleaguered health care law: Will it work?

The heart of the law springs to life Wednesday, after nearly four years of political turmoil and three months of enrollment chaos. Patients will begin showing up at hospitals and pharmacies with insurance coverage bought through the nation's new health care marketplaces.

The course of 2014 will show whether Obama can get affordable care to millions of people in need, without doing intolerable damage to the 85 percent of U.S. residents who already were insured.

Lots of Americans are nervous.

Will their new coverage be accepted? It's a concern because insurers have reported problems with the customer information they've gotten from the government, including missing data and duplication.

How many more people will see old individual plans that they liked canceled? Will a flood of newly insured patients cause doctor shortages? Will businesses respond to the law by ditching their group plans or pushing more health costs onto workers?

About three-fourths of people who face changes to their job-based or other private coverage in 2014 blame the health law, a recent AP-GfK poll found. Yet the trend of employers trimming costly health benefits predates the law that critics dubbed "Obamacare."

Many people should benefit immensely.

People previously locked out of individual insurance by high prices or pre-existing health problems can get coverage to stave off the threat of medical bankruptcy. More low-income workers will come under Medicaid, in states that agreed to expand the safety-net program. Middle-class families without workplace coverage can get tax subsidies to help pay for their insurance. How much patients like the new plans, and whether they can afford the co-pays and deductibles, will become clear as they start visiting doctors.

The new year also launches the most contentious aspect of the law: the mandate that nearly everyone in the U.S. have health coverage, or pay a fine.

All this will unfold during the super-heated politics leading to November's midterm elections.

Republicans and Democrats will jostle all year to influence the public's assessment of changes to American health care not matched since Medicare and Medicaid were launched nearly a half-century ago.

Some dates — and moving parts — to watch in 2014:

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JANUARY 1

— Coverage begins. Many low-income Americans who didn't qualify for Medicaid in the past can use it now. People who signed up for private insurance in a state or federal marketplace by Dec. 24 (or later in some states) and have paid their first premium are now covered, too.

—Coverage begins for workers at companies that have signed up for new small business plans through the marketplaces, also called health care exchanges.

—Coverage lapses for people whose existing plans were canceled, if they haven't signed up for a replacement or received an extension. At least 4.7 million people got cancellation notices, despite Obama's promise that Americans with insurance they like could keep their old plans. Obama recently gave insurance companies the option of extending old plans for existing customers for a year, but only where state insurance commissioners give their OK.