WASHINGTON -- Once President Barack Obama signs health-care-reform  legislation, some changes will take place immediately. But some of the most important provisions of the mammoth health bill aren’t set to take effect until 2014, or even later.

As we said in the first installment of this plain-English series on what’s in the health bill, health-care reform is a big, rambling, Rube Goldbergian machine.

And once the bill is signed and the Senate decides whether it will accept changes approved by the House, it will take time to set the system up and write the regulations that will govern its operations.

You’ll note that by 2014 the United States will have had two congressional elections. Three, if you count the one that will occur in late 2014 itself. And in 2012 there’s the little matter of Obama’s run for reelection.

That’s just to point out that the implementation of health-care reform could come in a very different political environment.

Things that happen first
The health-care reform bill makes a point of putting first the things that are supposed to happen first. They’re in subtitle A, right up top: “Immediate Improvements in Health Care Coverage for All Americans.” Things in the bill that take effect right away include:

• Insurance companies will be prohibited from placing lifetime caps - limits on the amount of money that can eventually be paid out - on their policies. They’ll face new restrictions on setting annual caps, as well.
• Insurance companies also will be prohibited from pulling your coverage, except in case of fraud or intentional misrepresentation.
• Children won’t be excluded from coverage due to pre-existing health conditions. Plus, children will be able to stay on their parents’ policy until age 26.
• Small businesses that offer health coverage to employees will be eligible for tax credits of up to 50 percent of premium costs.
• Seniors who fall into the coverage gap, or “doughnut hole,” in the middle of the Medicare Part D prescription drug coverage plan will get $250 to help them pay their bills.
• People with pre-existing health conditions will be able to enroll in a new, but temporary, national high-risk insurance plan.

Things that happen later
The central element of the superstructure of President Obama’s health-care reform effort is its individual mandate, as we described in part one of this series. Most people who live in the United States will be required to obtain health insurance.

But this does not kick in until 2014, when fines begin for those who don’t have coverage.

Similarly, the subsidies intended to make policy purchase affordable - the subject of part two of this series - don’t start until then. And the exchanges where individuals and small business can buy health insurance (you guessed it - part three) are not supposed to be up and running for four years, either.

Finally, one of the most popular provisions in the health bill, its ban on the denial of insurance coverage due to pre-existing health conditions, won’t take effect until 2014 either. That’s because insurers will need the flood of new customers brought in by the individual mandate to cushion the costs of accepting people who already have health problems.