This is the VOA Special English Economics Report.

President Obama has signed legislation to reform the health care system in the United States. The main goal is to insure about 32 million additional people. That is about 95 percent of Americans who are not already covered by Medicare, the government insurance program for older people.

About 16 million people will be added to Medicaid, the government health plan for the poor. The law will require Americans to have health insurance, with a few exceptions, or pay a fine starting in four years.

Also, in four years, employers with more than 50 workers will have to offer their employees a health insurance plan. Employers will pay a fine for each uninsured worker. Smaller businesses will receive tax credits to help pay for health plans.

People not covered by employer plans, Medicaid or Medicare could buy health insurance in marketplaces called exchanges. The idea is that competition among plans will drive down costs. States will provide these exchanges by 2014.

The law is the biggest change in American health care since 1965. But it is not a government operated health care system like the ones in other countries. President Obama says it provides limited reform.

BARACK OBAMA: "So this is not radical reform. But it is major reform. This legislation will not fix everything that ails our health care system. But it moves us decisively in the right direction."

Barry Arbuckle is chief executive of the non-profit MemorialCare Health System in Fountain Valley, California. He says the new law gets the issue of health reform moving. But he notes it is mainly health insurance reform. He says lawmakers will have to reform the way health care is provided. That means finding ways for hospitals, doctors and other providers to work together more effectively. Mr. Arbuckle also would like to see more attention on prevention so fewer people need costly medical treatment.

The law is expected to cost about 940 billion dollars over ten years. However, the Obama administration says the plan will cut the nation's budget deficit by more than 100 billion dollars during that period.

Last year, the United States spent two and a half trillion dollars on health care. This was an increase of almost six percent from the year before.

And that's the VOA Special English Economics Report, written by Mario Ritter. I'm Steve Ember.

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（來源：VOA 編輯：陳丹妮）