The Patient Protection and Affordable Care Act will have substantial effects on the US health care system. Physicians hold varied opinions regarding the overall merits or drawbacks of the health system reform law, but it is critical that we understand its components and the implications for our practices and our patients. This article describes the provisions most relevant to dermatology, analyzes the political and economic landscapes that shaped the legislation, and examines both opportunities and challenges that lie ahead. Physician leadership will be critical in future years as the regulations are written, the law is implemented, and legislative changes are considered.