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," Kraft said. "I need one to stay alive."
What's good for millions like 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-facing 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 receiving thousands of erroneous sign-ups from the government.
That means early in the year insured patients could go for a medication refill -- or turn up in the emergency room -- only to be told there is no record of their coverage.
One of the main worries is over certain error-tainted enrollment records that insurers call "orphans" and "ghosts."
"Orphans" are sign-ups that the government has a record of, but they do not 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 that the insurer does have a record of, but mysteriously the information 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 in the meantime, which means 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 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."