by Heather Hauswirth

Guam - Declaring "a new season in America", President Barack Obama signed the nearly trillion-dollar Patient Protection and Affordable Care Act into law today. The new law's most-far reaching changes don't kick in for another four years including a requirement that most Americans carry health insurance, whether through an employer, a government program or their own purchase - or pay a fine.

To make that a reality, tax credits to help cover the cost of premiums will start flowing to middle-class families and Medicaid will be expanded to cover more low-income people.

In a bold move, the President made it official signing the Act into law. While there is still uncertainly with exactly how these changes will play out with the territories, Dr. Thomas Sheih, president-elect of the Guam Medial Association, reacts to the news, saying he still has some concerns particularly with the expansion of Medicaid.

"What we need to be careful is expansion of Medicaid, if the Medicaid expansion to cover more people on Guam, you'll have to find physicians who will accept Medicaid, physicians are not forced to accept Medicaid, MIP or any of those plans," he said.

Dr .Sheih says to fix that problem, Public Health must make sure that the reimbursement rate is up to par for doctors so that they can contract to private doctors and make sure they will accept Medicaid, MIP and the other plans.

Meanwhile, this dramatic change in the healthcare system as we know may be a good thing for America, according to Calvo's SelectCare Administrator Frank Campillo, but Campillo says that he is not convinced reform will necessarily be able to contain the costs, saying, "Providing health insurance for more people is good for America, its can we afford it and that's the biggest problem. At one point the federal governments says we aren't able to afford it, states have to kick in and in this case the territories, and that's not guaranteed so the ink is too fresh, we still have to have what the Senate will do and say."

While the bill is now law, the president still has a lot of work to do to convince many Americans across the country that this will fix the healthcare system and the exorbitant insurance prices. "If you go back to initial reason," said Campillo, "we are reforming healthcare it is to retain costs, I don't see how we are going to contain costs. Nothing in this bill at this moment will when you are adding about 30-plus million lives to healthcare system it will add up to the cost and because of the changes that are being made that affect healthcare ins it will possibly increase costs specifically to small employers."

Looking forward, Campillo says this may be the end of health insurance that we know today and that in the next four years as new exchanges are created and new programs are managed by the office of personnel management, the health insurance industry may very well diminish as part of the reform is that the health insurance will face additional taxes and with an opportunity for individuals to have a public option, it may be more appealing to a majority of the population.

"Most will probably sign up for those exchanges because there premiums will be lower because they wont have taxes; we'll see it's too fresh, one of the things we do in America is adapt to new changes and I guess we'll have to see ultimately what the implications are and see how we adapt to that," he said.

Among the new rules on insurance companies are banning lifetime dollar limits on policies, coverage denials for pre-existing conditions, and policy cancellations when someone gets sick. Insurers also will have to allow parents to keep children on their plans up to age 26.