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The Patient Protection and Affordable Care Act (PPACA)[1][2] is a United States federal statute signed into law by President Barack Obama on March 23, 2010. The law (along with the Health Care and Education Reconciliation Act of 2010) is the principal health care reform legislation of the 111th United States Congress. PPACA reforms certain aspects of the private health insurance industry and public health insurance programs, increases insurance coverage of pre-existing conditions, expands access to insurance to over 30 million Americans,[3][4] and increases projected national medical spending[5][6] while lowering projected Medicare spending.[7] PPACA passed the Senate on December 24, 2009, by a vote of 60–39 with all Democrats and two Independents voting for, and all Republicans voting against.[8] It passed the House of Representatives on March 21, 2010, by a vote of 219–212, with 34 Democrats and all 178 Republicans voting against the bill.[9]