As with any amendment with social security or social policy, the program is wide encompassing. The United States has a significantly larger government than most countries in the world. It is difficult to tell the public how exactly they will be affected by the bill until local health departments in their state and country have come to a conclusion, or determined new budgeting options. This confusion generated from the implementation of the act has caused voters to look at health care reform from a pessimistic point of view, mixed with mistrust from the government that rose wildly in during the Bush Administration.

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