The Patient Protection and Affordable Care Act (PPACA or the Act), more commonly called the Affordable Care Act (hereinafter referred to as the Act), became law on March 23, 2010. The act is the most significant change in the American health care system since the passage of Medicare and Medicaid in 1965, and the greatest effect of the act is health insurance reform. The act requires certain employers to offer health care benefits to part-time employees, and this requirement may affect cities and fire departments using part-time firefighters. The focus of this section is on how the act affects cities and fire departments employing part-time firefighters and volunteer firefighters.