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President Obama signed comprehensive health reform into law on March 23, 2010. The Patient Protection and Affordable Care Act is an unprecedented joint federal-state initiative, with provisions to expand health insurance coverage, control health care costs, and improve the health care delivery system. This course will focus on the critical implementation period leading up to 2014. We will examine the federal regulatory process, the role that states will play in the expansion of Medicaid and operation of health insurance exchanges, the implications for the federal-state relationship, legal challenges, and Congressional oversight efforts