The Affordable Care Act (ACA), formally known as the Patient Protection and Affordable Care Act (PPACA) and informally as Obamacare, is a landmark U.S. federal statute enacted by the 111th United States Congress and signed into law by President Barack Obama on March 23, 2010. Together with amendments made to it by the Health Care and Education Reconciliation Act of 2010, it represents the U.S. healthcare system's most significant regulatory overhaul and expansion of coverage since the enactment of Medicare and Medicaid in 1965. Most of the act remains in effect.
The ACA's major provisions came into force in 2014. By 2016, the uninsured share of the population had roughly halved, with estimates ranging from 20 to 24 million additional people covered. The law also enacted delivery system reforms intended to constrain healthcare costs and improve quality. After it came into effect, increases in overall healthcare spending slowed, including premiums for employer-based insurance plans. The increased coverage was due, roughly equally, to an expansion of Medicaid eligibility and changes to individual insurance markets. Both received new spending, funded by a combination of new taxes and cuts to Medicare provider rates and Medicare Advantage. Several Congressional Budget Office (CBO) reports stated that overall these provisions reduced the budget deficit, that repealing ACA would increase the deficit, and that the law reduced income inequality.