The Internal Revenue Service (IRS), for example, interpreted the employer coverage requirements in a way that could make it difficult for more than 1.9 million Americans to afford coverage, according to an estimate by the American Action Forum, a conservative policy group.

Medicaid enrollment is responsible for much of the law’s coverage expansion—in New York alone, it’s up 11 percent—and yet the program’s longstanding problems with doctor access persist. In a September report, the Health and Human Services Inspector General reported that, as The New York Times put it, “the Obama administration and state officials have done little to ensure that new beneficiaries have access to doctors after they get their Medicaid cards.”

Access issues are not limited to Medicaid, though. In California, which has more Obamacare enrollees than any other state, the “state’s largest health insurers are sticking with their often-criticized narrow networks of doctors, and in some cases they are cutting the number of physicians even more,” according to the Los Angeles Times.

Some top health care providers are having trouble making the law work too.