Enacted in 2010, the landmark Affordable Care Act (ACA) made significant reforms in ensuring health care access and delivery. It is also one of the most litigated pieces of legislation in recent history, giving the courts an unprecedented role in shaping health care in the U.S. The ACA expanded access to Medicaid and subsidized private insurance through new Health Insurance Marketplaces for tens of millions of lower and middle-income Americans. For those with private insurance, including employer-sponsored coverage, the ACA advanced new insurance protections and market reforms, such as a ban on charging more or denying coverage for pre-existing conditions and guaranteed evidence-based preventive services with no cost-sharing. The ACA also advanced sweeping nondiscrimination protections across the health care industry.