Before the ACA, sick people often couldn't get health insurance due to a pre-existing condition. If they were able to get coverage, they often paid significantly more for it than someone without a pre-existing condition. Today, millions of Americans no longer have to worry about large bills due to annual or lifetime limits on benefits. Yet, there is still a serious affordability problem in the individual market, especially for those who rely on the individual market for coverage but are not eligible for financial assistance and those facing rising deductibles. Chapters 1 discuss ways to stabilize premiums and help individuals obtain affordable insurance through the individual insurance market. Healthcare reform should empower individuals and families to make decisions for themselves based on what fits their needs and their budget. One of the best tools we have to accomplish this goal is consumer-directed health plans that are paired with health savings accounts, or HSAs. These plans offer lower premiums and a higher deductible to encourage better use of healthcare services as examined in chapter 2 IHS provides care to American Indians and Alaska Natives through a system of health care facilities. The Patient Protection and Affordable Care Act (PPACA) provided states with the option to expand their Medicaid programs, and created new coverage options beginning in 2014, including for American Indians and Alaska Natives. Chapter 3 describes (1) trends in health insurance coverage and third-party collections at federally operated and tribally operated facilities from fiscal years 2013 through 2018, and (2) the effects of any changes in coverage and collections on these facilities.