FILE - This March 23, 2010 file photo shows Ttwenty two pens next to President Barack Obama as he signs the health care reform bill in the East Room of the White House in Washington. Your medical plan is  facing an unexpected expense, so you probably are, too. It's a new, $63-per-head fee to cushion the cost of covering people with pre-existing conditions under President Barack Obama's health overhaul. The charge, buried in a recent regulation, works out to tens of millions of dollars for the largest company health plans, and much of that is likely to be passed on to employees. Multiple pens are used to sign legislation, and then distributed to supporters of the legislation. (AP Photo/Charles Dharapak, File)