Obamacare to Command Continuing Headlines

Obamacare is destined to attract close scrutiny and major coverage in the coming year as full implementation takes effect.Obamacare faced a rough 2013, but it could be a walk in the park compared what lies ahead in 2014.

Elise Viebeck, writing for The Hill, identifies five significant stories to watch for in the coming year.

The most obvious is an analysis of how many people and who enrolled in the new health insurance exchanges. Chances are good the total will be less than the Obama administration's target of 7 million enrollees. Who signs up will be followed with intense interest. Will healthy young adults enroll? Will people desert employer-sponsored plans to shop on the exchange? How many people will be covered by the Medicaid expansion? Answers to these and similar questions will have an impact on rates, which also will earn close scrutiny.

President Obama has shown a willingness to postpone deadlines. Viebeck says he pushed back 10 separate deadlines in 2013. One of the biggest pressure points is the individual health care insurance mandate, a critical lynchpin to the overall success of Obamacare. Viebeck speculates Obama could look for more workarounds to entice broad participation.

The requirement that most employers provide birth control in their plans will go before the Supreme Court in two challenges. The issue arrives on the top court's docket after split decisions by appellate courts.

Another area the media will sniff out is further cancellations of existing health plans. While many of the cancelled plans may not have been a great value, the cancellation undermined Obama's claim that no one would be forced to change their health care plan, which in turn eroded political trust in the President and Obamacare itself. Short of plan cancellations, there will be careful analysis of whether newly offered plans trim costs by narrowing patient choices of doctors and hospitals. The Wall Street Journal already has published an initial analysis. But some patients accelerated elective surgeries before the end of the year to take advantage of their existing coverage.

After congressional Republicans took a hit in public opinion polls for their budget stand that led to a federal government shutdown, the balky beginning of HealthCare.gov and uneven implementation of Obamacare has led to plummeting voter confidence in Democrats. That means the 2014 mid-term elections, at least in the few House and Senate seats that are competitive, could be an indicator of the fate of Obamacare going forward. There still isn't a viable alternative — either practically or politically — on the table, but souring public attitudes on Obamacare could push the most adventurous and ambitious politicians to start sketching new options other than outright repeal.

Clearly, Obamacare will continue to command headlines in 2014.