The much debated Us Healthcare bill has been passed and signed by President Obama – marking the the biggest shift in U.S. domestic policy since the 1960s.

This bill will extend coverage to 32 million uninsured Americans and ban such insurance company practices as denying coverage to people with medical problems.

The first changes under the overhaul take effect by the end of September. Other changes would not kick in until 2014. By then, most Americans will for the first time be required to carry health insurance — through an employer, through a government program or by buying it for themselves. Those who refuse will face penalties from the IRS.

Tax credits to help pay for premiums also will start flowing to middle-class working families with incomes up to $88,000 a year, and Medicaid will be expanded to cover more low-income people.

The bill is expected to cut the US federal budget deficits by about $143 billion over a decade.