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When the clock strikes midnight for the new year Wednesday, it also will ring in a new day for the American health care system.

President Barack Obama signed the Affordable Care Act into law nearly four years ago, and Jan. 1, 2014, culminates a lot of work, strife and anxiety. It also represents the birth of a new health insurance market for individuals who aren’t covered by their employers or government programs like Medicare, especially for low-income and uninsured people receiving unprecedented help paying for coverage.

Starting on Wednesday, health insurance companies can’t turn away anyone because of their medical histories or pre-existing conditions. Prices can’t be higher for people with chronic ailments, or for women, and older individuals can’t be charged more than three times what younger customers pay. Basic benefits like hospitalizations, prescription drugs and mental health care must be covered. Annual and lifetime limits to essential coverage are gone. And nearly everyone must obtain health coverage or face a tax penalty under the law’s individual mandate.

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