On March 23, 2010, the Affordable Care Act (ACA) was signed into law, making it the most significant – if not most controversial – piece of health care reform in the United States since the introduction of Medicare and Medicaid in 1965. The survival of the ACA, commonly referred to as “Obamacare,” is all but guaranteed following the recent presidential election. A number of provisions of the law have already been realized, including an expansion of the Medicaid program, an extension of health insurance coverage for young adults and the introduction of free preventive care for those individuals who are already insured. Implementation of the most divisive provisions is yet to come. The establishment of health insurance exchanges, enforcement of the individual mandate and adoption of a physician care quality payment model will go into effect within the next few years.¹