This is a key chapter of the entire book as it describes the effects of the changes step by step. Chapter 3 covers the years 2014–2020. This is long enough to take a closer look at whether ObamaCare has been successful or not. A part of the chapter will focus on proving that ObamaCare gave rise to a phenomenon called the death spiral in the newly created Healthcare Insurance Marketplace. However, to better understand the course of this process, in the first place, the essence of this phenomenon and the factors that may contribute to its generation have been briefly presented. The analysis of the course of the death spiral will be divided into several stages occurring successively or in parallel: (I) the increase in the amount of insurance premiums; (II) providing higher tax credits for people with lower incomes; (III) the growth out of pocket expenses; (IV) the decline of the number of the insured; (V) lack of financial support for insurers and (VI) financial losses and insurers’ exits from Healthcare Insurance Marketplaces. This will allow a better understanding of the complexity of this phenomenon. It is worth emphasizing that the death spiral initiated by the ObamaCare regulation did not have its ‘classic’ position, but its negative consequences are felt by everyone: the insured, insurers, state governments, and the federal government. Like insurers, pharmaceutical companies also had to adapt to the new reality. The ObamaCare regulations imposed certain obligations and burdens on them, but also brought certain benefits – which was also described in detail. The topic of extending eligibility to the Medicaid program was also discussed.