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WASHINGTON It took lawmakers a year to shape President Barack Obamas health care bill. If it finally passes Congress, itll take the better part of a decade to write the user manual for consumers and doctors, employers and insurance companies.
Some health insurance consumer protections would go into place immediately, significant but limited in scope. The big expansion in coverage comes in four years. About 25 million people would sign up, with most getting tax credits to help pay premiums. Ripple effects continue well after Obama has to leave office in 2017, if hes re-elected.
But even if the 2,700-plus-page bill passes, its only the end of the beginning. The Obama blueprint will be carried out under less-than-ideal circumstances. Rising medical costs and an aging population will keep squeezing the federal budget. Lawmakers will have to revisit hard choices they sidestepped.
"This is going to play out over a generation," said Andrew Hyman, who oversees health insurance research for the nonpartisan Robert Wood Johnson Foundation. "It will address how people get coverage, how health care is delivered, and how health care is paid for."
The House is expected to vote on the final legislation this week, with the Senate to follow later. Heres a primer on some of the major effects for consumers and other key players:
Immediate changes
Uninsured people with medical problems will have a workable alternative. The bill pumps $5 billion into high-risk insurance pools run by the states to provide coverage to those in frail health. Taxpayer-backed insurance wont be free, but premiums should be much lower than whats charged by private insurers willing...