No one knows exactly how the nation’s health care system is going to change come Jan. 1, 2014, but Americans could be in for major surprises. Many of the provisions of the federal Affordable Care Act, popularly known as Obamacare, go into effect then, and we are getting some early hints about what is to come.

Obamacare isn’t the major reason, but it obviously played a part in the emergence of concierge medicine. We usually think of a concierge as a hotel employee who assists guests by arranging tours and making other reservations. In the medical field, patients get special treatment from concierge doctors.

Patients who can afford to pay the annual fees are turning to concierge medicine for their health care needs. The Advocate last month described how the system works. Those annual fees range from $200 a year to $1,500 or more. Concierge doctors limit their patient loads from 400 to 600 people, give them better service like same-day and longer appointments and 24/7 access to their doctors.

The newspaper said a number of reasons have been cited for the growth of concierge medicine. Many physicians believe the existing health care system is dysfunctional. They complain about constant reductions in the government payments they receive from Medicaid, the federal-state health care system for the poor, and Medicare, the government program for older Americans. And they don’t like increasing government interference in their daily operations.

One controversial Obamacare requirement has already been postponed for a year. It requires medium and large companies to provide health care coverage for their workers or face fines. The change means those companies have until Jan. 1, 2015, to set up health care for their workers.

Although the business community welcomed the delay, others point out the change won’t take place until after the 2014 mid-term congressional elections. Obamacare is so unpopular the new requirement is seen as troubling for Democrats seeking election in both the U.S. House and Senate.

House Speaker John Boehner, R-Ohio, said, “The president’s health care law is already raising costs and cutting jobs. This announcement (of a year’s delay) means even the Obama administration knows the ‘train wreck’ will only get worse. This is a clear acknowledgement that the law is unworkable, and it underscores the need to repeal the law and replace it with effective, patientcentered reforms.”

On another front, some companies report their health care premiums for employees have already gone up as much as 15 percent because of Obamacare. And they expect a similar rate increase or one even higher next year.

It should come as no surprise, then, that Politico, a political journalism organization, reported last week that “Obamacare is more unpopular than ever…”

An NBC News/Wall Street Journal poll showed only 37 percent of those surveyed think Obamacare is a good idea. A larger 49 percent say the act is a bad idea.

Insurance exchanges are one of the sources the uninsured will look to for help. Most are being set up by the federal government as places where people can buy health insurance with the help of federal subsidies. No one at this stage is really sure how that system will work.

The news also isn’t good for those who are disabled, according to The Advocate. They will lose their Medicaid eligibility after Jan. 1 and have to count on other sources for their health care needs.

The 9,800 Louisiana residents on the Disability Medicaid Program will have to count on the U.S. Social Security Administration to determine whether they are eligible for Supplemental Security Income benefits. The SSI eligibility process is terribly slow in determining whether people qualify.

The uncertainties and unknowns in Obamacare are unnerving to those who have adequate health care and to those who don’t. Neither group knows exactly what the new year will bring.

Nevertheless, 38 percent of those polled by NBC News and the Wall Street Journal said they believe the law makes them worse off. That is the highest figure the survey has found since President Obama signed the law. Only 19 percent said it would make them better off, and 39 percent said it wouldn’t make any difference.

Americans without health insurance have a more favorable view of the law than those who have coverage. That is because they have everything to gain and nothing to lose. However, 2 in 3 of them may lose out because their states have opted out of an expanded Medicaid program. Louisiana is one of those states, and up to 400,000 of its citizens won’t get the Medicaid coverage that currently pays doctors, hospitals and others who provide health care to the 1.2 million state residents already on its rolls.

National Journal, a political news magazine in the nation’s capital, got to the bottom line. It said the Obama administration can’t win on health care. Maybe not, but most of the new law’s provisions are still going into effect Jan. 1. And at this point, that looks like a scary proposition.