This essay, written for readers unfamiliar with the details of American health law and policy, portrays the essential features of the battle for health reform in the United States and of the law that survived the battle: the Patient Protection and Affordable Care Act (PPACA). The essay summarizes key aspects of the U.S. health care system and how it compares in terms of costs and results with other advanced nations’systems. The political and legal conflicts leading up to and following PPACA’s enactment are described. The major features of the law, attempting to address problems of access to health care, quality, and cost, are explained. Issues remaining to be resolved in the law’s implementation are set out: the expansion of Medicaid coverage for the low-income population; the formation of each state’s health insurance exchanges; cost-control measures such as the establishment of the Independent Payment Advisory Board and the adoption of new payment models; coverage of contraceptives as part of the essential benefits package; and the role of the new Patient-Centered Outcomes Research Institute. The essay concludes that the law is poised to achieve genuine progress toward increased access to health care, but that the law’s aims of improving quality and controlling costs are far less certain of accomplishment.