It will take some time to understand what exactly the health reform legislation means for the average American. Major reforms do not take effect until 2014, and at least four Congressional sessions, each with the power to modify the law, and a Presidential election will occur before they happen.
That said, there are changes that go into effect immediately, and their impact may influence the law's ultimate success or failure. Some of these changes raise costs for those who are currently insured, some provide financial assistance, some provide access. The net impact of these changes will be a mixed bag, with winners and losers.
Among the changes that will immediately increase costs are a prohibition against lifetime or "unreasonable" (definition TBD) caps on coverage. Some existing products rely on these coverage caps to lower premium costs. Another change that will increase costs is a requirement for first-dollar coverage of preventive services. Many cost-sharing products will have higher premiums due to this change. A third change is a requirement that businesses provide equal coverage for all full-time employees. It is unlikely that this change will lower costs for employers, many of whom are already booking liabilities associated with tax law changes included in the final bill.
On the other hand there are changes that provide financial assistance or access to coverage, some of which may or may not raise costs. A temporary high-risk pool for those with pre-existing conditions who have been uninsured for six months or more will begin to address the adult pre-existing condition problem. Children with pre-existing conditions must be covered by insurers, and their inclusion in the risk pool will no doubt be a cost problem. Small business will be eligible for tax credits to offset the cost of providing insurance. Except in cases of fraud so-called "recissions" of coverage will be prohibited.
I am afraid that the net impact of all this may create more losers than winners, since most people are insured and will see their rates rise. Remember that everything mentioned above happens on top of an annual medical cost trend that is running at two to three times the rate of inflation.