For starters, many Americans don't know much about what's coming. According to a recent Kaiser Family Foundation poll, a fifth believe that either Congress or the Supreme Court has killed the law. Some of them may be surprised to discover that they are required to buy health insurance on new exchanges beginning Jan. 1, 2014.
President Obama last month said nothing will change for the 85 to 90 percent of Americans who have insurance. That's not quite right. Even some people who are currently insured may see premium increases or, depending on their health, gender and age, reductions.
For example, the 10 percent or so who are in the individual insurance market will shop at "exchanges" new health-care marketplaces for individual purchasers where the currently uninsured also will go. The law protects the old and the sick, but that also means that some of the young and the healthy might have to pay more than they do now, particularly if price-control mechanisms don't work as well as hoped.
Merely setting up the exchanges is a massive job. There is not much time left to get the technology just right: integrating private insurance company systems with state and federal exchange websites and the Medicaid system. Republican-led states refusing to help implement the law make the task even harder.
There is also concern that the law will affect hiring decisions. It requires any company with 50 or more full-time employees or the equivalent in part-time workers to offer health coverage or pay a penalty. Will some companies cut hours to avoid being subject to that mandate? Will some choose not to hire that 50th employee? Perhaps, say some of the law's backers, but the universe of firms in the position to make these sorts of choices might also be relatively small.
A significant potential problem in implementation stems from the Supreme Court ruling. Obamacare expected to achieve its goal of near-universal health-care coverage in part by inducing states to expand their Medicaid programs. The court, in an opinion written by Chief Justice John G. Roberts Jr., ruled that the states could decline to do so.
Many states have taken the court up on its offer, though it means turning down massive federal subsidies and leaving nearly 8 million low-income Americans without health-care coverage, more than 2 million of them in Florida and Texas alone.
Even many strong supporters admit that there might be some bumps in the road ahead. Problems shouldn't be swept under the rug. But nor should the law's noble and useful goal: ensuring that as few Americans as possible go without health care.