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After the biggest expansion of federal health care coverage in more than 40 years, it's only a matter of months before America could start to see some changes.

For the first time in the country's history, most Americans will be required to get insurance. The government will provide tax breaks for those who can't afford insurance, but those who can and choose not be insured will face fines.

"It costs money to do what's here, so everybody is going to feel it," said Joanne Ruhland, vice president for government relations for Wake Forest University Baptist Medical Center.

She said she has mixed feelings about the new legislation.

"We as Americans, do we consider health care to be a right or a privilege? And depending on how you answer that determines whether or not government should play a role in it and how much your taxes should put toward that," said Ruhland.

While some of the changes won't take effect for several years, some components of the measure could go into effect in a matter of months.

In 90 days, there would be immediate access to high-risk pools for the uninsured because of pre-existing conditions.

Six months from now, the legislation would stop insurers from denying people coverage when they get sick. It would stop insurers from denying children with pre-existing conditions. It would also stop insurers from imposing lifetime caps on coverage and would require insurers to allow people to stay on their parent's policies until age 26.

"The devil is in the details. It is one big puzzle," Ruhland said. "We need to make sure that it's all coordinated."

Opponents of the measure are concerned over the big price tag. However, the nonpartisan Congressional Budget Office predicts that the new legislation will ultimately cut the deficit by $138 billion over the next decade.

Bill will have direct effect on Cary family

Families like the Willems praised Sunday night's passage of the reform bill.

Felicia and Ethan Willems play in a Cary park Monday. The bill passed by Congress will allow insurance coverage for Ethan, who has a pre-existing condition.

Their son Ethan almost lost his life after being born with a rare tumor.

"It's basically a really bad birthmark,” said Ethan's mom, Felicia Willems. “And it started swelling almost immediately, and it was trapping his platelets. So when he would cry, as newborns often do, it would bruise just from crying."

Ethan went through chemotherapy for almost a year. His father was in law school, and his mother had to quit her job to care for him. Medicaid covered almost everything.

"When he wasn't getting chemotherapy, he was getting physical therapy and speech therapy and occupational therapy, just to try to catch him up,” Felicia Willems said. “And, as you can see, he's a pretty normal 3-year-old now."

The family considered themselves very lucky, even though they had to sell their house and move in with Ethan's grandparents. Doctors say Ethan is now completely healthy.

Still, because he was born with a pre-existing condition, Ethan's mom says insuring him was impossible – until the House passed health care reform Sunday night.

"And even though he's been healthy for a year and a half now, it still counts as a pre-existing condition,” his mother said. “So that concern, now that this bill has gone through, is completely gone for us. Being able to see him be so normal, after all he went through, is just an amazing experience."

Small business owners worried

Richard Storm, of Albemarle, N.C., pays 100 percent of the health insurance premiums for the employees at the small business he owns. It accounts to $15,106.92 a month.

Richard Storm, owner of Storm Technologies Inc. in Albemarle, N.C., reviews his employee health insurance policy through Blue Cross Blue Shield.

"It's the right thing to do," he said.

But some congressional leaders say not every business owner is doing the right thing, and too many working Americans are uninsured. That means businesses like Storm Technologies Inc. will be penalized for doing the right thing.

"I don't want to fix something that's not broken," Storm said of his company's arrangement for health care.

While he says his company and employees have something that works, Storm said health care does need some work. Pre-existing conditions, preventative medicine and competition are things he said need to be addressed, but he said the government isn't the entity to do that.

"Of course, what worries me is government intervention and I'm understanding that they can audit our books, they can criticize our plan and make it difficult for Blue Cross Blue Shield," Storm said.

The plan approved late Sunday night calls for small businesses to pool resources to potentially lower costs across the board and provide tax benefits to cover more. The reform also calls for hefty fines on small businesses that don't provide insurance.

It's the so-called "cadillac tax" that will affect Storm. He said because he has a more expensive plan for employees, he'll be taxed.

"Nothing good for America, nothing good for our business and it's just going to be more taxes," he said of the 2,700-plus page reform bill. "The government is just making it harder for us to expand, harder for us to compete and they have targeted us and I feel like we're the good guys."