In March 2010 the American Congress passed a health care reform which requires every American citizen to buy a health insurance. To enforce the “individual mandate”, it is equipped with carrots and sticks, generous income dependent premium credits, on the one side, fines for those who default, on the other side. The funding measures include a “wealth tax” in the form of higher payroll taxes and a tax on unearned income for the rich. In addition to the premium credits for families with moderate incomes the reform is, therefore, al-so a remarkable redistribution program. The Congressional Budget Office has estimated that the reform will cost 940 billion US-dollar over the first ten years and reduce the number of uninsured by 31 million. Opposition against the law remains strong, however. Since the most significant parts will not go into effect until 2014, it remains uncertain if or in what shape the reform will survive