WASHINGTON All things good, bad and unpredictable converge with the new year for President Barack Obamas health care overhaul as the laws major benefits take effect, along with an unpopular insurance mandate and a risk of more nerve-wracking disruptions to coverage.

The changes bring big improvements for some, including Howard Kraft of Lincolnton, N.C. A painful spinal problem left him unable to work as a hotel bellman. But hes got coverage because federal law now forbids insurers from turning away people with health problems.

I am not one of these people getting a policy because Im being made to, Kraft said. I need one to stay alive.

Whats good for millions like Kraft is secured through what others see as an imposition: requiring virtually every American to get covered, either through an employer, a government program, or by buying a plan directly.

But the health care headlines early this year could come from continued unpredictable consequences of the insurance programs messy rollout.

The consumer-facing side of the HealthCare.gov website appears to be largely fixed with 2.1 million enrolled through federal and state websites. But on the back end, insurers say they are still receiving thousands of erroneous sign-ups from the government.

That means early in the year insured patients could go for a medication refill or turn up in the emergency room only to be told there is no record of their coverage.

One of the main worries is over certain error-tainted enrollment records that insurers call orphans and ghosts.

Orphans are sign-ups that the government has a record of, but they do not appear in insurer systems. Insurers say those customers never left the governments orphanage to go and live with the carrier they selected.

Ghosts are new customers that the insurer does have a record of, but mysteriously the information does not appear in the governments computers.

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President Obama’s tarnished health care law at a crossroads