Congress in March 2010 passed the Patient Protection and Affordable Care Act and almost immediately followed with amendments in the Health Care and Education Reconciliation Act of 2010 (together, the “Act”). From any perspective, passage of the Act constituted an historic step toward reform of the United States healthcare system. Much less clear, however, has been the Act’s future. Almost exactly two years after the Act made it through Congress, the U.S. Supreme Court in March 2012 devoted three days to review of key parts of the legislation. In late June 2012, the Court upheld key components of the law. But the Act faced yet another challenge in 2012 with the national presidential and congressional elections. The Republican Party presidential candidate, Mitt Romney, pledged early on to “work with Congress to repeal the full legislation as quickly as possible.” When Barack Obama won the presidency and the Democrats retained control of the U.S. Senate in the November 2012 elections, the specter of outright health reform repeal dissipated. Questions about implementation remain, however, and all the uncertainty has made the planning process difficult at best for employers.