Nearly 30 years after President Nixon proposed the first major overhaul of the health care system, comprehensive reform became a reality when President Obama signed the Patient Protection and Affordable Care Act (ACA) on March 23, 2010. The ACA is expected to cover 32 million currently uninsured people by expanding Medicaid, offering subsidies to purchase insurance, and prohibiting preexisting condition exclusions. Like Presidents Carter and Clinton before him, Barack Obama campaigned on a promise of health care reform.