单选题 Passage Four President Obama has signed legislation to make the biggest changes in the health care system in forty-five years. 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 ban 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. Illegal immigrants will not be able to take part. An estimated 83% of people under 65 who are in the US legally now have insurance coverage. The plan is expected to raise that to 95% within several years. People over 65 are covered by the Medicaid 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 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 Medicaid coverage for some drug costs for older Americans. President Obama promised senior citizens that the reforms will not cut their guaranteed benefits. The changes are expected to cost about $940 billion over ten years, but also help reduce the federal budget deficit.