That’s the subject of my story in the newest issue of dead-tree TIME, which looks at some of the ways that Congress is already undercutting many of the promised reforms in the health care system. As is often the case when politicians and interest groups get hold of a big and complicated piece of legislation, you have to look deep into the fine print to figure out what is really going on.

A couple of provisions that have been quietly inserted in the Senate bill are causing no small amount of heartburn in the Obama White House at the moment, because they call into question whether some of the most crucial reforms called for in the legislation will ever actually happen: