There’s no doubt that health care reform is a monumentally historic event, yet the only thing residents of Southwest Florida can agree on is their ignorance over the details of the far-sweeping piece of legislation.

Health care is a complicated issue. And those who haven’t had time to analyze a substantial bill inundated with dozens of smaller amendments are simply taking the “wait-and-see” approach.

“It’s hard to tell yet, until I see what the whole thing is about,” said Cape Coral resident Steve Greenstein.

A senior citizen, Greenstein said he supports the bill to help the poor receive medical care, but his concerns lie with cuts to Medicare that average 21 percent nationwide due to the system’s outdated method of dispersing funds.

And the $950 billion health care reform bill signed this week didn’t deal with those cuts.

Smaller health care providers such as the Family Health Centers of Southwest Florida – with an office in Cape Coral – typically treat a majority of the low-income, uninsured population. Vice-president Bob Johns said he doesn’t support the bill and not because he doesn’t want health care reform.

“We think the health care bill keeps community health centers in the forefront of health care for the uninsured, poor or migrants,” he said.

Johns, like other health care administrators, can’t say exactly what is going to happen with reform because the bill is so extensive – more than 2,000 pages – and Congress passed it without a lot of details given to the public.

“There are a lot of questions that still need to be answered,” he said. “People are just figuring out now what is on individual pages or sections.”

With mandates on approximately 30 million uninsured people to find some type of coverage, Johns doesn’t know if many of the patients at Family Health Centers will choose private doctors once they have insurance, and therefore more options for care.

Of course, physicians are experiencing those cuts to Medicare reimbursement, and as a result may stop seeing Medicare patients altogether or go out of business, meaning more people may be forced to visit local community health centers to receive their primary care.

The contentious legislation reportedly mandates all American citizens to get insurance or face a penalty, prevents insurance companies from dropping people with pre-existing conditions, forces businesses to provide coverage for their employees and a number of other changes to an already crumbling system.

But not everyone is satisfied with every provision in the law.

“There are many problems that need to be addressed,” said Cape Coral resident Dan Goodrich. “Probably, there were hidden deals made to get people to sign the bill.”

Goodrich, who lives in Rhode Island half of the year, said the legislation is unfair because it raises the threshold of deductions for medical expenses from 7.5 to 10 percent, meaning patients with significant health costs will be able to deduct less on their income taxes.

Yet some are optimistic about the bill, including part-time Cape Coral resident Paul Napierkoski, who said the bill will take some time to change the system, but it should benefit the country in the long run.

“I think it was good, we needed a change,” he said. “There are going to be bugs in it and it will take time to iron them out.”

Small businesses are also concerned with how much they need to spend on employee healthcare. Premiums on employer-based health care plans have already skyrocketed over the past decade with no end in sight.

Officials from Marine Concepts, a Cape Coral business on Pine Island Road, invited U.S. Congressman Connie Mack, R-Fort Myers, to tour the facility and ask him what can be done to decrease the amount of taxes on small businesses.

They are now concerned that health care reform will drive up the amount of taxes they owe to the federal government.

The company saw its staff go from 135 to 20 after the economic crash in 2008, but now employs close to 60 people. In a letter to Marine Concepts employees, CEO Bob Long stated that 33 percent of the company’s profits go to paying income taxes and an additional 25 percent pays for Medicare and FICA.

“We pay half of our employees’ health care costs and we’re just surviving and barely making it, and these costs keep piling on,” said Long.

He said it’s disappointing that Congress didn’t address tort reform in the health care bill and stave off some of the costs by limiting things like malpractice lawsuits. According to a 2005 Dartmouth Medical School study, the average payment from a malpractice settlement has increased by 52 percent between 1991 and 2003.

Long said he isn’t sure if the reform bill will lower premiums for employee healthcare.

“That remains to be seen, that is what they are claiming, but I am having trouble seeing how,” he said.

Small businesses aren’t the only ones concerned about government’s increased presence in health care. Kathleen Fitzsimmons, a Cape Coral resident, said she doesn’t like the idea of the government having such a stake in healthcare.

“It’s not that I don’t want everyone to have health care, I’m just wary about the government taking over everything,” she said, adding that she is concerned what will happen to seniors, including her 95-year-old mother who has lived in this region for 30 years.

Lali Ballerini explained she doesn’t really know what changes are in the bill, but said she is skeptical that health care costs will go down once the government steps in.

“When it comes to the government it will never go down, you’ll pay for it one way or another,” she said.

Congressman Mack, an opponent of the reform bill, released a statement earlier this week. He also drafted a bill to repeal the law signed by President Barack Obama. Stephanie Dubois, spokesperson for Mack’s office, said Friday the bill had four Republican co-sponsors, including Rep. John Duncan and Rep. Mark Souder, both from Tennessee, Rep. Walter Jones from North Carolina and Rep. Todd Tiahrt from Kansas.

“The American people have spoken loud and clear, and that’s why I introduced this legislation to repeal the health care reform plan,” Mack said. “Once we repeal this flawed law, we must enact policies that keep taxes low, spending in check, and our freedoms in place, such as health savings accounts, association health plans, substantial medical malpractice reform and tax incentives.”

Florida Attorney General Bill McCollum and 13 other states have also filed a lawsuit against the law claiming it’s unconstitutional.

U.S. Sen. Bill Nelson, D-Florida, is supporting the reform, according to a speech he gave this week on the Senate floor, although he wanted the reform to also address rising drug costs.

“It has been said by many folks in many different ways that we are not put on Earth for ourselves, but are placed here for each other,” he said. “Therefore, despite its flaws, I will vote to pass this legislation.”

Jim Nathan, president of the Lee Memorial Health System, said he was disappointed that both Congressional parties didn’t work together on the reform bill.

“It’s truly sad that our political divisiveness resulted in an inability to have both parties collaborate on behalf of our nation,” he said in a prepared statement. “I believe there could have been a better and more sustainable product and far better education, if there had been true collaboration.”

According to Nathan, the reform bill deals with getting insurance for those who can’t afford it, resolves the problems of annual or lifetime caps, shrinks the “donut hole” affecting Medicare patients -Southwest Florida has twice the national average of Medicare patients – and allows children to stay on their parent’s plan until they are 26.

Of course, he added there are a lot of “unknowns,” including how long it will take to expand coverage, how much of the changes will be passed on through higher insurance premiums or drug costs, and how hospitals will get adequate payment for medical services.

According to Nathan, Medicare – which is paid through payroll taxes – is estimated to go bankrupt in 2017, and that was projected before a national 10 percent unemployment rate. He added there isn’t enough in the fund to pay for the baby boom generation which is ready to retire and is living 10 years longer.

A phenomenon referred to as the “hidden tax,” where uncompensated care is covered by higher insurance premiums for others, is hitting Lee Memorial Health System. The percent of insured patients paying for shortfalls has decreased each year from 35 percent in 2007 to 25 percent this year.

“This is not a sustainable model,” said Nathan in a prepared statement.