President Obama signed the Patient Protection and Affordable Care Act (PPACA) on March 23, 2010, and the Health Care and Education Reconciliation Act (HCERA) on March 30, 2010 (PPACA and HCERA are referred to collectively in this Article as the “Act”). The Act is both very complex and very controversial. The federal agencies have already issued voluminous guidance, with far more to come. Current challenges to the Act have taken two main forms: a challenge to the constitutionality of the Act’s individual mandate (see Section IV.B.1[b] below) and an attempt to repeal the entire Act (see Section XII below) which, given Democratic control of the House and the Presidency, is more symbolic than real. However, Republicans will probably try, through the appropriations process, to stifle implementation of the Act. Also, many of the most important provisions are not effective until 2014 or later, and so may be repealed or amended if the Republicans take control of the Senate and the White House in the 2012 elections. This Article will discuss the background of attempts to reform the health care system, and the major problems addressed by the Act: costs and cost increases; the uninsured and the under-insured; consumer protections; waste; and the quality of care.