The Affordable Care Act (ACA) expands access to coverage to millions of Americans, a goal health plans have long supported, but major provisions will raise costs and disrupt coverage for individuals, families, employers, and Medicare and Medicaid beneficiaries. The broad market reforms outlined in the ACA take effect on January 1, 2014. Individuals and families purchasing insurance in the individual market will be guaranteed coverage for pre-existing conditions, and their premiums cannot vary based on their gender or medical history. There will also be subsidies to help consumers afford the cost of coverage, and new health insurance exchanges will help consumers find the policies that best meet their needs. At the same time, other provisions take effect that will significantly increase the cost of coverage, such as the health insurance tax, minimum essential benefits, and restrictions on age rating. $52 billion in new taxes will be imposed on businesses by mandating that employers provide health insurance. New taxes on drug companies ($27 billion) and medical device makers ($20 billion), as well as new reporting requirements and regulations imposed on physicians, will make access to health care and services more costly and difficult for seniors under Obamacare.The cumulative impact of all of these provisions increases the likelihood that some individuals will choose to purchase insurance only after they become sick or injured, further increasing the cost of coverage for everyone else with insurance. The ACA also takes a number of preliminary, but promising, steps toward reforming the delivery system to improve patient safety and quality in Medicare and Medicaid. Many of these initiatives build on successful private-sector programs that health plans have pioneered and implemented.Nearly one-quarter of all seniors rely on Medicare Advantage, the private health care