WASHINGTON -- All things good, bad and unpredictable converge with the new year for President Barack Obama's health care overhaul as the law's major benefits take effect, along with an unpopular insurance mandate and a risk of more nerve-wracking disruptions to coverage.
The changes bring big improvements for some, including Howard Kraft of Lincolnton, N.C. A painful spinal problem left him unable to work as a hotel bellman. But he's got coverage because federal law now forbids insurers from turning away people with health problems.
"I am not one of these people getting a policy because I'm being made to," Mr. Kraft said. "I need one to stay alive."
What's good for millions such as Mr. Kraft is secured through what others see as an imposition: requiring virtually every American to get covered, either through an employer, a government program or by buying a plan directly.
But the health care headlines early this year could come from continued unpredictable consequences of the insurance program's messy rollout.
The consumer side of the HealthCare.gov website appears to be largely fixed -- with 2.1 million enrolled through federal and state websites. But on the back end, insurers say they are still getting thousands of inaccurate sign-ups from the government.
This means that early in the new year, insured patients could go for a medication refill -- or turn up in the emergency room -- only to be told that there is no record of their coverage.
One of the main worries is regarding certain error-tainted enrollment records that insurers call "orphans" and "ghosts." "Orphans" are sign-ups the government has a record of, but that don't appear in insurer systems. Insurers say those customers never left the government's "orphanage" to "go and live" with the carrier they selected. "Ghosts" are new customers the insurer does have a record of, but the information mysteriously does not appear in the government's computers.
The Obama administration says the rate of such errors has been dramatically reduced, and insurers agree. The catch is that the volume of sign-ups has surged, which means that, even with a lower error rate, the number of problem cases keeps growing. And there is no automated way to clear up mistakes quickly.
"Some people are actually going to start using their coverage Jan. 1, and that is a good thing for them," said Mark McClellan, who oversaw the rollout of Medicare's prescription drug benefit -- a program that also had its share of launch issues. "But there are going to be problems for any number of people who thought they had signed up, and it won't work right off the bat. It would be particularly disruptive for people in the midst of treatment."
Anticipating disruptions, major drug store chains such as CVS and Walgreens have said they'll help customers who face glitches, even providing temporary medication supplies without insisting on up-front payment. Many independent pharmacies are also ready to help.
White House health care adviser Phil Schiliro said Tuesday the administration was working with insurers and health care providers to minimize disruptions, "as we deal with what are always going to be unexpected problems where there is a transition."
Mr. Obama had envisioned that the arrival of the Affordable Care Act's major benefits in 2014 would be like a national seminar, showcasing his philosophy that government can and should smooth the rough edges of an unforgiving economy for struggling working people. The goal was that in a midterm election year, Democrats would be able to point to millions of newly insured Americans, thanks to subsidized private plans and an expanded version of Medicaid. Media reports would feature compelling cases of people literally handed a lifeline.
That is indeed happening, but it seems to be only part of the story. The Republican portrayal of "Obamacare" as inept and out of control government appears to be unfolding right alongside.
Although the stated goal of the law was to cover the uninsured, at least 4.7 million insured people had individual policies canceled that didn't measure up to new requirements. That forced an apology from the president, who had famously promised that if you like your health plan, you can keep it. The administration says it believes most of those people have secured new coverage.
Americans with job-based health plans are also worried. A recent Associated Press-GfK poll found that most people who have seen their employers scale back coverage blame that on Mr. Obama's law, even though businesses were shifting health costs to workers before the law passed.
The nation's divisive debate over health care could go on for years. For now, administration officials say they are focused on just getting through the March 31 end of open-enrollment season. People who enroll by that date will not face the law's tax penalty for remaining uninsured.