The national health care bill and the nine-​​month saga that led to its pas­sage swept the country into an emo­tional and polar­izing debate. But even after Pres­i­dent Barack Obama signed the bill, many Amer­i­cans were left to ponder what it all means to them. Here, David A. Rochefort, a North­eastern Uni­ver­sity polit­ical sci­ence pro­fessor, breaks down the law and its implications.

How will this leg­is­la­tion ulti­mately affect the average Amer­ican?
The effects promise to be far-​​reaching, although it will take time for all of the changes to occur. Among the first groups to ben­efit will be seniors, due to expanded drug cov­erage in Medicare, and young adults, who very soon will be able to remain on their par­ents’ health plans until age 26. Another change this year will be tax credits to help small busi­nesses pro­vide health ben­e­fits. Also, pri­vate insurers will no longer be able to deny cov­erage for chil­dren with med­ical problems.

How­ever, it won’t be until 2014 that the law kicks in fully by bringing insur­ance cov­erage to an esti­mated 32 mil­lion Amer­i­cans. For this, nec­es­sary mea­sures will include Med­icaid expan­sion, penal­ties for larger employers who don’t offer health ben­e­fits, man­dates for unin­sured indi­vid­uals to pur­chase cov­erage, and out­lawing cov­erage exclu­sions for pre-​​existing med­ical con­di­tions among all insured. How­ever, the mil­lions of Amer­i­cans who have and retain good health insur­ance cov­erage from their employers will prob­ably not see any sub­stan­tial change.

Politi­cians seem to be at odds over whether this law will save money or add to the deficit. What is your take?
Yes, Repub­li­cans have com­plained about insuf­fi­cient cost con­tain­ment com­bined with enhanced cov­erage and ben­e­fits under the new law. The pres­i­dent and his sup­porters received a major boost when the Con­gres­sional Budget Office found the law would dra­mat­i­cally lower the fed­eral deficit over time.

How to resolve this con­tra­dic­tion? Many inef­fi­cien­cies mark our cur­rent health care system, such as the use of costly emer­gency room ser­vices by the unin­sured, which will decline as people gain cov­erage. Future cost con­trol is likely to depend on whether prospec­tive reforms in the law actu­ally bear fruit, and on deci­sions yet to be made by law­makers and reg­u­la­tors who oversee the program’s implementation.

What will change in Mass­a­chu­setts as a result of this national bill?
Mass­a­chu­setts not only has a law aiming at uni­versal insur­ance cov­erage, its pro­gram served as a model, in many ways, for the Democ­rats’ approach. Nonethe­less, national health care leg­is­la­tion will lead to some impor­tant changes here, including more fed­eral funding for the state’s Med­icaid pro­gram, a larger number of res­i­dents becoming eli­gible for insur­ance sub­si­dies and an increase in fed­eral sup­port for the state’s Com­mu­nity Health Cen­ters. New taxes on high-​​end insur­ance plans and Medicare pay­roll tax increases for high-​​income earners will also even­tu­ally affect cer­tain groups in Mass­a­chu­setts. A dis­crep­ancy between national and state law regarding employer and indi­vidual non-​​compliance penal­ties will need to be straight­ened out. The fed­eral law has a lesser penalty for those who don’t comply with the indi­vidual cov­erage man­date, and the fed­eral penalty for employers who don’t offer insur­ance kicks in for com­pa­nies having 50 or more workers, in com­par­ison with the cur­rent state threshold of 11 or more workers.

Will there be enough health care pro­fes­sionals to treat the cur­rently unin­sured Amer­i­cans who will be cov­ered? Will more doc­tors and nurses be needed?
This is a sig­nif­i­cant ques­tion, one among others that tended to fall below the radar during the debate. The new leg­is­la­tion pro­vides funding for the National Health Ser­vice Corps and for increasing Med­icaid reim­burse­ments for pri­mary care physi­cians. It also bol­sters family med­i­cine training pro­grams. In the face of con­cerns about a shortage of active nurses in this country, the law invests in nursing work­force devel­op­ment. Notwith­standing such actions, the supply and dis­tri­b­u­tion of health pro­fes­sionals are likely to remain impor­tant issues.