ABSTRACT
Health care reform is one of the defining elements of Barack Obama’s presidential record. Likely to appear as the most central aspect of his domestic legacy, the Patient Protection and Affordable Care Act (PPACA) is a controversial piece of legislation that proved extremely hard to enact, as it generated strong opposition from Republicans and their Tea Party supporters. Although the legislation was passed in March 2010, it is being implemented gradually, over nearly a decade and there is much uncertainty about the long-term fiscal and policy effects of key PPACA provisions. Finally, the very implementation of major aspects of the legislation is problematic, as suggested by the decision in autumn 2011 to cancel its long-term care programme because of cost-related issues.
