The enactment of the Affordable Care Act (ACA) in 2010 was the most monumental change in US health care policy since the passage of Medicaid and Medicare in 1965.1,2 Despite a bill that was more than 900 pages, the primary goals of the legislation were clear: increase the number of individuals with health insurance; improve the quality of care; and tame the seemingly inexorable increases in the cost of care.