The federal Affordable Care Act (ACA) aims to expand health coverage for up to 32 million uninsured Americans. It relies on a combination of health insurance reforms, insurance exchanges in all 50 states, Medicaid expansions, subsidies, tax credits and mandates. The law also allocates funds to improve quality and halts certain widely criticized insurance practices. The biggest changes come in January 2014 when Medicaid expands and health insurance exchange or marketplace policies pay for care . States have considered and acted on hundreds of ACA-related laws, with more to do and decide for 2014.