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DEBATE SURROUNDING HEALTH CARE REFORM AND the Patient Protection and Affordable Care Act (PPACA) was contentious and focused mainly on disagreement about the costs of providing insurance to more Americans. Minimal discussion was devoted to how reform might change chronic disease outcomes, even though chronic diseases represent a major source of unsustainable growth in health care costs. Because of its numerous provisions, the PPACA has the potential to reshape the treatment and course of chronic diseases in America. The degree to which the PPACA brings about changes in chronic disease management will depend on whom the law affects, how specific provisions alter service delivery, and how recent discoveries in chronic disease prevention and treatment affect health outcomes.