The ink is barely dry on President Barack Obama’s signature, triggering historic and sweeping health care reform.

Obama signed the bill into law late this morning after the bill passed the House of Representatives 219-212 on Sunday.

Under the health care bill, by 2014, most Americans would be required to have health insurance or pay a fine, with the exception of low-income Americans. Employers would also be required to provide coverage to their workers or pay a fine of $2,000 per worker. Companies with fewer than 50 employees, however, are exempt from this rule.

“That part of the bill is concerning, from an employer and an economic standpoint,” Bryan W. Whitfield Memorial Hospital CEO Mike Marshall said. “If you’ve got 52 employees and you’re required to provide coverage to all of them, what do you think a lot of the smaller businesses are going to have to do? They’re going to find a way to get under that 50-employee threshold. That may mean cutting jobs.”

The Congressional Budget Office predicted the bill would cost $938 billion — mainly through a mix of tax increases and reduction in Medicare spending — and would reduce the federal deficit by $142 billion in the first 10 years. The health care bill would extend insurance to 32 million more Americans.

“If their figures are correct — and I’m not sure that they are — there are still going to be about 12 million people without insurance,” Marshall said. “If the goal was to make insurance available to everyone — and I think it should have been — then they’ve settled on a bill that’s going to fall short of that goal.”

Cuts in Medicare spending, Marshall continued, were cause for further alarm.

“They already pay us less than what it costs to treat Medicare patients,” he said, “but there are provisions that, if passed, may actually increase what’s paid to rural doctors.”

Even with so much unknown about where this new legislation is headed, Marshall said the law does appear to provide a small boost to the Demopolis hospital.

“If it works like it’s supposed to — and that’s a pretty big ‘if’ — then it will cut down on indigent care and bad debt,” he said, “and that’s a good thing. But with all the other things — the cuts to Medicare and Medicaid — this bill isn’t as good as it could have been.”

Nearly 60 percent of Americans receive health insurance through their employers, and if those Americans make less than $200,000 annually, they are unlikely to see any significant changes with the passage of this bill.

But the bill will affect those in the high-income bracket and poor Americans who currently cannot afford health coverage.

The Senate is currently debating a “reconciliation package,” which could alter the new bill significantly.

However, as of Tuesday, here are some of the major effects of the health care reform bill:

Effective this year, insurance companies would be barred from denying coverage to children based on pre-existing conditions. Effective immediately, they will also be prevented from placing lifetime caps on policies, or from dropping a patient’s insurance if the policy-holder falls ill.

Effective this year, insurance companies would be required to cover preventative services, including vaccines that are recommended by the Centers for Disease Control and Prevention.

By 2014, insurance companies will be prohibited from denying coverage to adult patients with pre-existing medical conditions or increasing their rate due to these conditions.

Effective this year, parents can keep their children on their insurance plan until the age of 26.

Starting this year, once Medicare prescription drug participants reach their “cap” ($2,830), they will receive a $250 rebate. Effective in 2011, those who go beyond the “cap” will receive a 50-percent discount on prescription drugs.

Individuals with incomes of $200,000 or higher and families with combined incomes of $250,000 will be subject to a new 3.8-percent “Medicare Tax.”

By 2014, most Americans would be required to have health insurance or pay a fine, with the exception of low-income Americans.

Those who are at 133 percent of the federal poverty level, or $29,327 for a family of four, would be eligible for Medicaid, starting in 2014.