Recent healthcare reform has raised budgetary and legal concerns among many lawmakers, insurance companies and physicians.

A new mandate for universal health insurance violates interstate commerce rights protected under the Constitution, some have said, and puts an unfair burden on taxpayers. Attorneys general in at least 14 states threatened to file lawsuits against the legislation.

The Patient Protection and Affordable Care Act, which was passed by Congress and signed by President Barack Obama last week, also prohibits companies from charging higher health insurance quotes for individuals with poor health or rejecting children with pre-existing conditions.

Robert Rusbuldt, president and chief executive officer of the Independent Insurance Agents & Brokers of America told BestWeek about his industry's concerns toward the bill.

"It's going to be a wild ride for the next year or so," he was quoted as saying. “At the end of the day, we think this bill is fundamentally flawed and that it will not work as intended in the marketplace."

A recent survey by athenahealth and Sermo showed that many physicians are also worried that reform could contribute to lower healthcare quality. Fifty-nine percent of respondents expected the quality of care to decline in the next five years.

One of Republicans’ primary gripes with the healthcare reform is its mandate for universal coverage. This provision may have been there idea, according to a recent report by the Associated Press.

Similar legislation was passed on the state level by former Massachusetts Governor Mitt Romney in 2006. That year’s Massachusetts Health Reform Law required middle-income consumers to purchase health insurance or pay a substantial fine.

Romney has since been critical of the Obama administration’s healthcare overhaul, saying that it represents a federal takeover. Republican attorneys general from other states have threatened to file suit against the reform on the basis of its constitutionality.

Mark Pauly, a health economist from the University of Pennsylvania’s Wharton School, wrote a paper in 1991 suggesting that mandates be combine with tax credits, an idea that was well-received by the George H.W. Bush administration, according to the report.

"It could have been the basis for a bipartisan compromise, but it wasn't," he was quoted as saying. "Because the Democrats were in favor, the Republicans more or less had to be against it."

The healthcare reform bill passed in the U.S. House of Representatives last weekend with no votes from Republicans. It was later signed by President Barack Obama, then passed to the Senate for approval. Congress passed a reconciliation bill days later.

Federal reform may be among the factors that causes healthcare quality to decrease in the next five years, according to a recent survey by athenahealth and Sermo.

Fifty-nine percent of respondents in the Physician Sentiment Index felt that the quality of healthcare would decline during that time, while more than half said the current healthcare climate is detrimental to their work. In addition to federal reform, the physicians pointed to the business of medicine and reimbursement protocols among the variables that would weaken the system.

"Physicians want to focus on being the best doctors they can be, but there are all these things getting in the way," said Jonathan Bush, CEO and Chairman of athenahealth. "They're caught between caring for their patients and remaining viable businesses."

Ninety-two percent of respondents said that getting paid by insurers has become increasingly complex, according to the report, with many of them also finding Medicare and Medicaid payments burdensome. More than two-thirds felt time spent with payors and other third parties took away from their work with patients.

In addition to mandating universal healthcare, the reform bill recently passed in Congres would prohibit companies from charging higher health insurance quotes for individuals with poor health or denying coverage for those with pre-existing conditions.

Critics of healthcare reform have taken issue with the bill's penalties for those who choose not to purchase insurance. They have said that the government does not have the right to tax individuals for being alive and that such fees are unconstitutional.

A recent column by Christian Science Monitor guest blogger Howard Gleckman defended the bill's mandate for universal coverage. He described a common situation when health insurance would be required - following a car accident - and pointed to the fact that EMT will never demand proof of insurance before providing care.

"Conservatives like to argue that healthcare is not a right," Gleckman wrote. "But, in fact, it is. For years, federal law has required most hospitals to accept patients into their emergency rooms whether or not the sick and injured have the means to pay."

This leads to higher health insurance quotes for those who do purchase insurance. States, like Virginia, that have passed laws barring the universal mandate could consequently contribute to higher premiums for the rest of Americans, according to the report, or even cause some private insurers to go out of business.

A senior official from the Obama administration recently said that lawsuits against healthcare reform were "without merit," according to Washington-based blog The Hill.

Healthcare reform will not lead to lower health insurance quotes for same-sex couples, according to a recent blog post by NYTimes.com.

Current healthcare legislation does not count employer-sponsored insurance as taxable income when it is used to cover the spouse in an opposite-sex couple. Because members of same-sex couples are not considered dependents under the bill, health insurance coverage offered to the domestic partner of a gay employee is taxed.

An earlier version of the House of Representatives' healthcare reform bill eliminated this tax. This language was removed from the bill most recently signed by President Barack Obama.

Healthcare is among the highest extra costs incurred by same-sex couples, according to the blog, because many employers do not offer coverage for domestic partners.

"If you don't have the option through your own employer, or through your partner's to get insurance in some manner, there will now be this additional mechanism, the health insurance exchanges, to get individual coverage," Brian Moulton, chief legislative counsel at the Human Rights Campaign, told the blog.

Federal reform is slated to make health insurance more affordable by offering tax credits to families and preventing insurers from charging higher premiums for people with poor health.