The Patient Protection and Affordable Care Act (PPACA), was enacted by President Obama on March 23, 2010. This act is the most significant attempt at revamping the healthcare system since 1965, with the passage of Medicare and Medicaid. The impact of this act effects a majority of health care outlets, insurance companies, businesses, and most individuals in the United States. The practices of physicians and hospitals where they practice would feel the impact financially and clinically as the drive to offer better health care at lower costs, while making themselves more accessible. The intention of the Affordable Care Act, (ACA), was to increase the quality of health insurance, making it more affordable, lowering the uninsured rate and expanding insurance coverage. Mandates, insurance exchanges, and subsidies were introduced, along with a law that would require insurers to accept all applicants with a coverage of a specific lists of conditions and a guarantee to charge the same rates regardless of sex or pre-existing conditions. As the end result, the Congressional Budget Office in 2011 projected that future deficits and Medicare spending would be reduced as a result of the ACA (Secretary, HHS Office of the). With the establishment of ACA, there is intent to achieve a near-universal guarantee of affordable health insurance coverage. When the law is fully implemented, the desired result is for 94% of the American population to have health insurance coverage. The act also aspires the following:Improvement of fairness, affordability, and quality of health insurance coverageImprove the value, quality, and efficiency of the health-care systemAccountability of the health-care system to a diverse patient populationStrengthen primary health-care access, along with availability of primary and preventative health care (Rosenbaum, S. 2011).The employer mandate requires all employers, with 50 or more full time employees, to offer health insurance benefits. This will increase the financial demands on employers, along with a greater demand for alternate models of health insurance. Plans that were purchased by employers may have been cancelled because they did not meet the ten health benefits, which resulted in a higher cost of replacement insurance. Employees may lose their employer sponsored health care plans if a business’s finds it less costly to pay the penalty and to let their employees purchase a health plan on the exchanges. Small businesses may find better plans run through state-run exchanges (Amadeo, K. 2016)Penalties can be imposed on companies that don’t qualify as providing affordable healthcare coverage. To determine this, the ACA will determine if an employer pays a significant portion of their employee’s coverage. An employee cannot pay more that 9.5 percent of their income towards health care coverage. If the employees pay more, the plan is not considered affordable, and the company would pay a penalty. The health care plan must pay at least 60 percent of the covered healthcare expenses. If the employer’s plan fails to do this, it is not considered affordable. The employer must comply on both instances, or it can be penalized (Lorenzen, R. 2013).