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This is the VOA Special English Health Report.

President Obama has signed legislation to make the biggest changes in the health care system in 45 years.

BARACK OBAMA: "Today, after almost a century of trying; today, after over a year of debate; today, after all the votes have been tallied, health insurance reform becomes law in the United States of America. [Applause]"

Many parts of the plan will fully take effect in four years. But some take effect quickly. For example, in six months the new law will bar insurance companies from denying coverage to children with pre-existing health conditions. Adults with pre-existing conditions will be added in four years.

The government will help millions of people pay for insurance. It will also permit millions more to receive free coverage through the Medicaid program for the poor.

In all, the plan aims to make health insurance available to 32 million people now without it. People will be able to buy private policies through marketplaces called exchanges to be administered by the states. Illegal immigrants will not be able to take part.

An estimated 83 percent of people under age 65 who are in the United States legally now have insurance coverage. The plan is expected to raise that to 95 percent within several years.

People over 65 are covered by the Medicare insurance program which the government created in 1965.

For the first time, Americans will be required to have health insurance or face a yearly fine starting in four years. The law will also require companies with more than 50 employees to offer coverage. If not, they could face a fine of 2,000 dollars a year for every worker.

Also, this year the law will start closing what is known as "the doughnut hole." That is a lack of Medicare coverage for some drug costs for older Americans. President Obama promised senior citizens that the reforms will not cut their guaranteed benefits.

He signed the bill Tuesday at the White House, before Democratic lawmakers and people with stories of health insurance problems.

BARACK OBAMA: "We have now just enshrined, as soon as I sign this bill, the core principle, that everybody should have some basic security when it comes to their health care."

The president said he expected the Senate to quickly make a last set of legislative fixes needed in the new law. Republicans are promising to fight the Senate bill. And some states have already gone to court to fight the new law.

The changes are expected to cost about 940 billion dollars over ten years, but also help reduce the federal budget deficit.

And that's the VOA Special English Health report, written by Caty Weaver. I'm Steve Ember.

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（来源：VOA 编辑：陈丹妮）