Abstract
The Patient Protection and Affordable Care Act (PPACA) created dramatic changes in the healthcare payment and delivery systems in the United States. Widely hailed as the largest restructuring of healthcare delivery since the Johnson administration, the PPACA has been reshaping the American healthcare landscape since 2010. While much of the discussion surrounds the original contents of the bill, it is important to consider the changes in the legislation since its enactment 3 years ago. Although these changes can easily be interpreted through a partisan lens, it is critical to consider the evolution of the PPACA as objectively as possible, in order to better understand the potential impact of shifts in policy. The following discussion will attempt to (1) describe the three major changes in the PPACA since its passage in 2010; and (2) reflect on the implications for the overall American healthcare system and orthopaedic surgeons.
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