The healthcare law faced a very tough year in 2013, but that could pale in comparison to what happens in 2014.
Between new exchange plans taking effect in January, the first enrollment period concluding in March and the midterm elections in November, the administration will have its hands full managing the rollout and mitigating negative stories for vulnerable Democrats.
Here are the top five stories to watch:
The end of March will bring analysis of how many people enrolled in ObamaCare's new insurance exchanges. The administration hoped for 7 million in its first sign-up period, but it's possible that the technical problems that initially plagued HealthCare.gov could cut into that total. Federal health officials also are expected to release details about the risk pools, like the age breakdown of enrollees. Without strong sign-ups from young, healthy patients, prices could dramatically rise for coverage on the exchanges next year. Supporters of the law point to policies designed to mitigate this effect, such as the Affordable Care Act's risk corridors.
2) Midterm Election
Vulnerable Democrats will be held to account in 2014 for problems with ObamaCare's botched rollout, including the promise from many that patients could keep their coverage if they liked it. Both parties are already preparing for a vicious campaign cycle as the GOP works to take control of additional Senate seats, and ObamaCare could play the leading role if no other issues seize the foreground. Democratic campaign officials are publicly bullish about the party's chances, particularly given the addition of longtime political executive John Podesta at the White House, but privately express concerns that ObamaCare will drag down incumbents.
3) Delays? Workarounds? Shake-ups?
Almost anything is possible as the Obama administration works to ease pressure created by the rollout's problems. Officials have shown they're very comfortable with delaying parts of implementation, with at least 10 instances of pushed deadlines in the last year alone. It's also possible that the White House will propose relief under the individual mandate for people who encountered problems at HealthCare.gov. When it comes to personnel, no heads have rolled within the administration for the problems at HealthCare.gov, creating the possibility that another crisis will force leaders out.
4) Supreme Court to rule on birth control mandate
ObamaCare's controversial requirement that most employers cover birth control in their health plans is headed to the Supreme Court. The justices agreed to hear two challenges to the mandate from Hobby Lobby, a craft-store chain, and Conestoga Wood Specialities, a cabinet-making company. The owners of both corporations say that covering a range of birth-control methods for female workers violates their religious liberty. The 10th and 3rd Circuit Courts of Appeals split on the issue, all but ensuring that the high court would eventually take it up. The decision will be the Supreme Court's first ruling on ObamaCare since declaring most of the law constitutional in June 2012.
5) Further cancellation notices
The political firestorm over insurance cancellation notices may not be over for the White House given the likelihood that some employers will drop their coverage next year. By 2016, the Congressional Budget Office has projected that 6 million fewer people will receive employer-based health insurance compared with 2013. While experts say the healthcare law is not the cause of the shift, the Obama administration will have to defend any further upheaval in the insurance market as Republicans continue to hammer the changes.