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About 7 million people are expected to buy insurance through the marketplaces in the first year. But it's more important to watch who signs up rather than how many. For these new insurance markets to thrive, they'll need to take in more in premiums then they spend on health care, so they need more healthy buyers than sick, economists say.

The current system, researchers say, financially encourages doctors to do more procedures and is one of the reasons health costs have escalated. The health law required Medicare to gradually factor in quality into payments for hospitals, nursing homes, physicians and most medical providers.

Medicare had already decided that large physician groups -- those with 100 or more doctors, nurses, social workers or other health professionals -- will gain or lose as much as 1 percent of their pay starting in 2015. Those incentives would double to 2 percent the following year under draft regulations Medicare released this month. The proposal also would phase mid-sized physicians groups—those with between 10 and 99 health professionals—into the program in 2016 instead of in 2017. While they would be eligible for bonuses up to 2 percent, they would be shielded from any penalties for that first year.

Under the Affordable Care Act, insurance plans offered in the new marketplaces will have to cover a core set of services called “essential health benefits.” Included on the list of 10 benefits are mental-health and substance-use disorder services, which include behavioral health treatment, counseling and psychotherapy. Specifically, as part of what’s considered preventive services, plans will also cover alcohol-misuse screening and counseling, depression screening for adults and adolescents, domestic and interpersonal violence screening for women, and behavioral assessments for children.