Decades in the making

When the president signs the Patient Protection and Affordable Care Act into law at the White House this morning, it will be the culmination of what some Democrats describe as a century-long struggle to move the U.S. toward universal coverage. Democratic presidents since Harry Truman have tried to reform the nation's health care system, and President Lyndon Johnson signed the law establishing Medicare for the elderly, the last most significant change to the system in 1965.

The new bill expands coverage to 32 million Americans, but it will not create a government-run public option or cover all Americans. At a cost of $940 billion over 10 years, the bill is supposed to reduce the federal deficit by $138 billion, according to estimates from the nonpartisan Congressional Budget Office.

In what seemed to be a symbol of the various administrations that have wrestled with this issue, Secretary of State Hillary Clinton, who championed health care reform in 1994 during her husband's presidency, congratulated President Obama with a broad smile and a hug before a meeting at the White House Situation Room on Monday.

In a year in which Democrats have been criticized for allowing Republicans to steal the momentum, the party celebrated a major victory this week in what some are calling the most significant social legislation since the 1960s. Still, conservatives are promising to repeal the bill and make lawmakers who voted for it suffer at the polls in November.

Some of the elements in the bill, including a so-called "individual mandate" requiring all Americans to be insured, will not take place for several years. But other features of the bill will take place almost immediately.

Among them:

• Insurance companies will no longer be allowed to drop customers from coverage when they get sick. Effective this year.
• Insurance companies will no longer be allowed to deny coverage to children with pre-existing conditions. Effective this year.
• Adults who are uninsured because of a pre-existing condition will be allowed to join a temporary subsidized high-risk insurance pool. Effective this year.
• Young adults will be allowed to stay on their parents' health care plans until their 26th birthday. Effective this year.
• New private insurance plans will be required to cover preventive services with no co-payments and no deductibles. Effective this year.
• Small business tax credits of up to 35 percent of premiums will be immediately available to firms that choose to offer coverage. Effective this year.
• Insurance companies will no longer be allowed to place lifetime caps on coverage. Effective this year.
• Medicare payments will be reduced for seniors in the Part D donut hole who will receive a $250 rebate. Effective this year.