Kelly Kennedy, USA TODAY

WASHINGTON - Starting Wednesday, the Affordable Care Act was in full force, as millions of uninsured Americans either now have health coverage or will get it this year.

But experts say that's just one of many changes to watch for in 2014, including how the law will affect elections, what the states will decide about Medicaid expansion, and what insurers will do to react to their quickly changing demographics.

Already, at least 1.1 million people have gained coverage through the federal exchange, HealthCare.gov, and the federal and state exchanges stand to enroll millions more through the cut-off date at the end of March. Beginning Jan. 1, insurers may no longer preclude people from buying insurance because of pre-existing conditions; they may not charge older people much-higher premiums than younger people; they may not charge women more than men; and they must share pricing and benefits information to their consumers in an apples-to-apples way.

Beyond the law's new requirements, analysts and industry officials say they anticipate a series of related changes to affect health care in 2014, including:

Private exchanges. Insurers will bring more private exchanges to the workplace, and people will begin to understand they have to control their own health costs instead of relying on benefit-heavy insurance plans to do that for them, said Alan Cohen, chief strategy officer for Liazon, a company that provides private exchanges.

"I think we're going to see dramatic, dramatic increases in people who use private exchanges," Cohen said. "There was a big increase this year, but it will pale in comparison to next year." Employer mandate. Employers will also start making changes to prepare for the requirement that companies with more than 50 employees provide health insurance for their employees, said Hector De La Torre, executive director of the Transamerica Center for Health Studies. That requirement was supposed to start Jan. 1 but was delayed a year by the Obama administration.

"Employers are really going to be on the clock for 2015 for their mandate kicking in," De La Torre said. "That will be interesting throughout the year as regulations come into play."

More employers and insurers will also start offering wellness discounts, which are meant to encourage employees to take better care of themselves in order to get lower premiums, he said.

Pricing transparency. Regardless of the political storms surrounding the law, the health industry is proceeding with the assumption it is here for good, said Ceci Connolly, managing director of PWC's Health Research Institute.

Read more here:

Health Care Changes to Watch for in 2014