ABSTRACT
The United States of America (US) is the only developed nation that does not have a universal system of healthcare coverage, and there has been a long-standing debate about how to structure the healthcare system to provide access to care. In 2010, despite fierce opposition, the US Congress passed the Patient Protection and Affordable Care Act (ACA) (US Congress 2010) and President Barack Obama signed the Act into law. While this law represented a sweeping reform of the US healthcare system with provisions to expand coverage and to control costs, it also included provisions to improve the quality of healthcare and foster innovation in research and design of the healthcare delivery system. The ACA has encountered many political and logistical barriers to implementation, but has also sparked many health system reforms and innovation aimed at improving the quality and efficiency of healthcare delivery. It is too early to judge the ultimate impact of this landmark legislation.
