Precisely 2 years after he's out of office, just in case it doesn't actually turn out the way they claimed. That way they'll have 2 years of cover under a different administration and X number of years under a different congressional power structure on which to blame the failure.
Actually, he's basically claiming that in 4 years time the law will be in full effect and that's when you get to start running the clock on measuring things. This is, of course, shinola of the highest order. More or less immediately a number of radical changes will be put in place:
1) All health care policies will be forced to cover preventative care costs. This effectively eliminates high deductible, low premium policies. Given this is federal mandate, this is essentially a new tax on everyone who had a high deductible plan who now has to pay much higher premiums for a health insurance plan. The idea here is that more people paying high premiums will lower the per person premiums. Good for some, grossly unfair to others, including those businesses that utilized such plans to great effect and high employee satisfaction, such as that Whole Foods grocery chain that made the news last year. There is also ample evidence through studies of all kinds that increased preventative care is not a cost saver, since unnecessary preventative care ends up costing more than it would have to pay for things as they come up (also false positive diagnosis causes waste of resources and money).
2) Health savings accounts will now have a new, lower maximum cap of $2500 dollars. These accounts allowed for tax free saving of money that could only use used for out of pocket health care costs (co-pays, deductibles, uncovered office visits, etc.). These kind of go hand in hand with #1 since those that put big bucks in them tended to be on higher deductible plans.
3) No denial for prior existing conditions. While perhaps a moral good, it is absolutely a net loser for insurance companies and their current policy holders in terms of necessary premium increases.
4) Health insurance company executive deferred compensation packages are capped at $500k. This is unprecedented outside of the recent interventions in the car, bank, and general insurance industries, particularly without a "bailout" at play in this case. This will lead to good CEOs and business persons seeking employment outside of the health insurance industry, hurting the companies, the employees, and the insurees over time. Not to mention it is a gross violation of private enterprise.
5) No dropping people off a policy, including no lifetime caps on payout amounts. Similar to #3 this may be a moral good, but it is going to cost money to premium payors. Many people prefer to get plans with lifetime caps as a means to get lower premiums, no longer an option. I'm also unsure how it is going to work if a person already has a plan that has caps or has aplan that doesn't cover some condition they develop (say something like psychological treatment). ... oh wait...
6) All plans have to cover a myriad of services, many of which make no sense for certain genders or lifestyles (for instance, people who don't drink alcohol). While this may make sense for family plans, individual plans which cover all these items is wasteful to the point of view of the insuree and is, again, essentially a tax on those people designed to subsidize those who need those services covered.
7) Premium rate increases will now reviewed and under the direct control of HHS, even on private plans and those outside the exchange. Again, an unprecedented intrusion into the private enterprise and one which will, if exercised, lead directly to all the ill effect of price controlling that we've seen play out over and over again in the past.
And that's just for starters...
We will not need to wait for 4 years to see the effects of this bill and we will not be waiting until then before we start paying attention and marking things pro or con in the ledger of review for this congress or this President.