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Circle these dates: Health law's key tests in 2014

Tuesday - 12/31/2013, 3:10am  ET

FILE - This Nov. 29, 2013 file photo shows part of the HealthCare.gov website in Washington, on Nov. 29, 2013. The new year brings the big test of President Barack Obama’s beleaguered health care law: Does it work? The heart of the law springs to life Jan. 1, 2014, 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.(AP Photo/Jon Elswick, File)

CONNIE CASS
Associated Press

WASHINGTON (AP) -- 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.

--The clock starts on the "individual mandate." Nearly all U.S. citizens and legal residents are required to have "minimum essential coverage" for most of 2014, or pay a penalty. Most people already are insured through their jobs, Medicare, Medicaid, or military coverage and so don't need to do anything.

--Insurance companies are no longer allowed to turn away people in poor health or kick customers out of plans when they get sick.

--Women and people with pre-existing conditions pay the same rates as healthy men in the new plans. The law also limits how much more insurers can charge older people.

--New insurance plans can't put an annual dollar limit on care, or require individuals to pay more than $6,350 in out-of-pocket costs per year.

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JANUARY 10

Payment due. In most cases, marketplace customers who signed up by Dec. 24 have until now to pay the first month's premium and get coverage for their January medical bills. Major national insurers agreed to accept payments 10 days into the month because of technical troubles plaguing online enrollment at HealthCare.gov. But buyers should check early with their insurance companies -- some may not honor the grace period. A few states running their own marketplaces are granting even more time. Those who miss their deadline can get coverage starting Feb. 1.

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JANUARY 31

-- A temporary program for people denied coverage because of poor health ends. Tens of thousands of Americans with serious illnesses such as heart disease and cancer were in the special program and needed new coverage for 2014. The Pre-Existing Condition Insurance Plan, originally set to expire Dec. 31, was extended one month to help sick people whose enrollment was stymied by HealthCare.gov computer crashes.

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