You may have noticed that the exchange and the public option in the Senate bill won't kick in until 2014. Political cover, funding and administrative set-up are the excuses.
But Ezra enumerates the reforms that will go into effect immediately after the bill is signed by the president.
This one looked interesting:
7) Forcing insurers to spend 80 percent of all premium dollars on medical care (75 percent in the individual market), thus capping the money that can go toward administration, profits, etc.
Currently, 30-40 percent of health insurance premiums go to overhead and profit. This is a significant improvement and allows that hole to be further closed over time.