This health care reform bill passed late last night and soon to be signed into law is a seriously flawed piece of legislation, for it fails to achieve the goals of real health care reform. Now that it is essentially the law of the land, the country needs to work diligently at the federal and state levels to correct many of the most egregious problems with the legislation before the reform package fully goes into effect in 2014. The six main areas that need to be fixed are: cost control, enforcement, individual mandate, abortion, competition, and immigration.

1) Lack of Real Cost Control

This bill does not create real cost control and will not bring down premiums for most Americans. Congress and state legislatures need to adopt real cost control measures like: drug re-importation, Medicare direct drug price negotiation, a public insurance option, Medicare buy-in, or a central provider reimbursement negotiator (all-payer system). These changes would save the government and regular Americans hundreds of billions of dollars over the next decade.

The bill also needs to provide a better pathway for states to opt-out of this bill so they can experiment with better health care models that could truly bring down cost.

2) Dangerously Weak Enforcement

There are some good new regulations, but regulations are only as good as the strength of the agency tasked to enforce them. This bill is dangerously lacking in this area, leaving enforcement mainly up to the same state insurance commissioners that now often lack the will, funding, or power to hold the private insurance companies honest. Only a national exchange and a federal insurance commissioner would have the power to make sure the new regulations are more than over-hyped window dressing.

3) Individual Mandate

The individual mandate, which uses the IRS to force people to buy a product from a poorly regulated, private industry, is an affront to the American people. The policy is not needed, and must be corrected before it has a chance to go into effect. People must be offered the choice of a public alternative, or the individual mandate must be repealed. Alternatives like a back premium payment system could achieve a similar policy goal to an individual mandate without a massive expansion of the IRS or government coercion.

4) Abortion

This bill is a massive rollback of a woman’s right to choose. It would take away the abortion coverage of millions of Americans. The system of exchanges and affordability tax credits could easily be modified to ensure federal funds are not used to pay for abortions, while still not taking away the ability of women and small businesses to buy insurance packages that cover abortion. Having an individual mandate that forces women to buy insurance, but also a law that prevents them from getting insurance that covers a legal medical procedure, is a disgusting abuse of women’s rights.

5) Lack of Health Insurance Competition

The bill will do almost nothing to address the problem of lack of competition in the health insurance market. Repealing the anti-trust exemption and adding a public option would be two big steps toward solving the problem. Creating an all-payer system would make it easier for new insurers to enter new markets. Requiring a standardized insurance package, instead of a confusing set of choices based on actuarial value, would allow Americans to do real apples-to-apples comparison shopping. Finally, adding much stronger risk adjustment mechanisms would force insurance companies to compete on quality instead of on avoiding the sickest Americans.

6) Immigration

Under this almost-law, undocumented immigrants would not be allowed to buy insurance on the new exchanges, even if they are willing to pay the full cost of the insurance with their own money. This policy is not only cruel and immoral, but fiscally irresponsible. The more undocumented immigrants that pay for their own health care, the more taxpayers save by not being forced to pick up the cost of undocumented immigrants’ uncompensated care when they use the emergency rooms.

The White House and Democratic leaders have made many promises about health care reform throughout this long and winding process—from guaranteeing affordable, quality care for everyone to pledging tougher regulation of the medical industrial complex that created this broken system in the first place. If the majority party wants to honestly deliver on these promises—not to mention if they want to remain in the majority—then a concerted and immediate effort is required to prove that this week’s legislation is truly the first step toward reform, and not the last.