In March 2010, H.R. 3590, the Patient Protection and Affordable Care Act (PPACA, P.L. 111-148), and H.R. 4872, the Health Care and Education Reconciliation Act of 2010 (HCERA, P.L. 111-152), collectively referred to as the Affordable Care Act (ACA), became law. Provisions in the statutes affect the financing, access, delivery, quality and virtually every facet of the health care delivery system for many years to come. The ACA is comprised of ten titles that: make fundamental changes to the regulation of health insurance; restructure the insurance marketplace through establishment of American Health Benefit Exchanges; expand eligibility of the Medicaid program; offer an array of workforce, public health, and health care quality related provisions; and permanently reauthorizes the Indian Health Care Improvement Act. State options offered in the ACA, and new requirements make it essential for state policymakers to stay informed in order to make the most effective choices for their constituents.