The Patient Protection and Affordable Care Act (ACA) of 2010 clearly builds on the existing health care system in the United States. By creating health insurance exchanges, the ACA attempts to extend the use of private insurance companies to expand coverage. It also attempts to improve existing public programs, namely, Medicaid and Medicare. Frank J. Thompson's essay on Medicaid and Daniel P. Gitterman and John C. Scott's on Medicare both analyze how the programs will change under the ACA and consider the political aspects of reform.

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