New Year's Day will bring a fresh test for President Barack Obama's health care overhaul, as hundreds of thousands of Americans will begin to use the program's new medical coverage for the first time.
For the nation's health care system as well as its politics, the stakes are huge in Wednesday's launch of Obamacare.
For anxious Democrats with an eye on the 2014 congressional elections, it is a chance for the Obama administration to rebound from the disastrous rollout of the website that enrolls people in private coverage through the program — and show that the White House's effort to help millions of uninsured and underinsured Americans is finally gaining its footing.
Or, as Republican congressman Fred Upton and other critics of Obamacare warned in recent days, Wednesday could represent the beginning of another debacle that fuels Republicans' push to make dissatisfaction with Obamacare the chief issue in the November elections.
More immediately, the question is whether the program will work as advertised on Jan. 1, after a chaotic enrollment period in which problems with the HealthCare.gov website led to a series of deadline extensions and undermined public support for Obamacare and the President.
The White House said early Sunday that about 1.1 million people have enrolled in coverage plans through the federally run HealthCare.gov, which covers 36 states. That figure does not include the latest enrollment data from 14 states that run their own healthcare enrollment sites — including California, Connecticut, Kentucky, New York and Connecticut — and where response to Obamacare has been enthusiastic, so the total enrollment nationally is likely more than 1.5 million.
That is well short of the 3.3 million enrollees administration officials were hoping for by now, but it represents a dramatic improvement from a month ago, when barely 150,000 had signed up because of a series of technical problems with the HealthCare.gov site.
Many of the newly insured under the Patient Protection and Affordable Care Act — about 975,000 on the federally run exchange — signed up just ahead of a deadline on Dec. 24 to receive benefits on Jan. 1, giving health insurers a tight framework to create accounts that can be accessed by doctors.
One fear, as expressed by administration officials and insurance industry executives, is that some people who need medical care during the first days of 2014 will head to the doctor, only to find there is no record of their new insurance.
That could mean patients would have to pay upfront and submit a bill to their insurance carriers later.
And even though the Obamacare program is not directly responsible for the private insurance purchased through its online exchanges, White House officials have acknowledged that any early problems with the coverage are likely to reflect on the administration.
Some insurance executives say that even a few stories of coverage problems during the next few weeks — which seems inevitable when dealing with such a massive program — could damage the reputations of the White House and the healthcare overhaul."The big moment of trust is 12:01 a.m. on January 1st, when a mother is standing in a pharmacy with a baby in her arms trying to get a script filled," Aetna Inc. Chief Executive Mark Bertolini said this month. "Getting that information right so that we don't have these events which ultimately end up in our lap if we don't do them well, it's very important for us all to get it right."
A senior administration official acknowledged "there will be bumps in the road."
"We need to plan for them, we need to anticipate and we need to make sure that we are ready to respond," the official said.
Physicians say they are used to dealing with changes to patients' insurance coverage and it is not unusual for there to be lag times between enrolling in a new insurance policy and the time it becomes official.
Some doctors will be willing to delay billing. Others may not be.
"Come the start of the year there will be dueling narratives: the people who have never had insurance before who are actually getting decent care for the first time in their lives, and people who are having issues with the administration's new policies," said Dan Mendelson, chief executive of Avalere Health, which has been tracking the healthcare overhaul.
"They are going to kind of cancel each other out," he said. "Three months from now when we are in the electoral cycle, the policies will be judged on the basis of enrollment (numbers), rather than any technical problems."
Mendelson expects the early 2014 problems to be limited given the light pace of enrollment spread out across the nation, and the fact that hospitals and other providers are experienced in troubleshooting coverage questions for patients.