Today is the day for ObamaCare.

President Obama’s signature law takes effect on New Year's Day 2014, giving approximately 2.1 million enrollees the chance to exercise their new plans at hospitals and clinics across the country.

ADVERTISEMENT

That will open up a new set of challenges for the administration in a midterm election year that might hinge on how well the healthcare law plays across the nation.

The White House emerged from 2013 battered after enrollment delays linked to a troubled website put it behind its projections of getting 7 million people enrolled in 2014.

Poll numbers showed support for the law dipping along with Obama’s approval rating amid stories about the troubled website and reports of people losing their existing insurance despite the president’s promise they could keep it under the new law.

That erased a generic ballot edge Democrats had enjoyed over Republicans after the government shutdown, which had boosted hopes in Obama’s party that they would retain the Senate and take back the House.

While enrollment appeared to surge in December, experts warn the bottom could fall out as the 2.1 million enrollees visit their physicians.

Enrollment deadline delays and processing errors at HealthCare.gov have been an administrative nightmare for insurers, and might leave some consumers discovering that they don’t have the insurance they thought they purchased when they show up at the doctor’s office.

It’s also likely that some people think they have insurance under ObamaCare but do not because they have yet to make their first premium payment. Until they do, they aren’t actually insured.

In Washington and Nevada, only about 50 percent of enrollees have made their first premium payments. Those are the only states that provide the breakdown.

“The biggest risk now is people thinking that by picking a plan, that they’re insured, when in fact final step is paying the premium,” Larry Levitt, a senior vice president with the Kaiser Family Foundation, told The Hill. “I haven’t seen good numbers on how many people are paying premiums, so that to me is the uncertainty.”

The administration adopted a confident tone on Tuesday, even as it acknowledged some enrollees are likely to experience problems.

“We’re very excited about tomorrow, but we’re vigilant,” White House senior adviser Phil Schiliro said on MSNBC. “We don’t want anybody to have problems, but we know some people will.”

Separately, in a conference call with reporters, Schiliro emphasized that the White House has been working with other stakeholders in advance of Wednesday.

“We’ve been working very closely with the insurers, the pharmacies and the doctors to ensure there’s as little disruption as possible,” he said.

Examples of that cooperation include some big insurers allowing consumers to pay their first premium by Jan. 10 and still be insured on Jan. 1.

In addition, Walgreens and CVS Pharmacies announced this week that they will provide up to a month of no-cost medications to consumers who haven’t received their ID cards yet, but can prove they enrolled.

There’s little doubt the success of the healthcare law will be a big factor in Democratic efforts to retain the Senate, where Republicans need to gain six seats to win back the majority.

Doing so would be a huge blow to Obama’s remaining years in office, virtually assuring him lame-duck status through the rest of his term.

So there’s a lot at stake for the administration to ensure things go smoothly, starting on New Year’s Day.

Centers for Medicare and Medicaid Services spokeswoman Julie Bataille said Tuesday the administration is confident those enrolled in the healthcare exchanges realize they need to make payments to get their insurance.

They realize “what the next steps are in terms of securing coverage,” she said.

And John Holahan, a fellow at the nonpartisan Urban Institute, said the idea that people will be blindsided is foolish.

“If they don’t pay, they don’t have insurance. That’s part of the deal. You’re not really enrolled,” he said. “But I assume anyone who goes through the trouble of enrolling will go ahead and pay.”

The administration has pulled out all the stops over two months to fix the website and boost enrollment.

It has repeatedly extended deadlines for enrolling in healthcare to ensure coverage by Jan. 1, arguing it was important to make sure people could be insured by then despite the faulty website.

But that could cause problems starting Wednesday, as pushing the deadlines has created huge headaches for insurers.

“Health plans are working around the clock to process the high volume of enrollments that they have received from the exchanges,” said America’s Health Insurance Plans spokesman Robert Zirkelbach.

“While there are still some ongoing challenges with the back-end systems, including so-called 'orphan records,' where the enrollment files are never received, health plans are working with CMS to resolve those issues as quickly as possible so that consumers' coverage can begin in January,” he said.

Joe Antos of the conservative American Enterprise Institute predicted the flood of applications would be too much for the administration and the insurers to handle before the newly covered head out to exercise their plans.

“There’s no way the insurance industry could hire enough people to process all that paperwork if the data was coming in correctly, and it’s not,” he said. “I think most people who think they have coverage will find some difficulty early in January.”