This is part 1 of a 4-part series on the Affordable Care Act (ACA). The ACA will continue to impact ophthalmology practices in many ways and at different levels. This include the addition of more patients now covered by insurance, the expansion of Medicaid, new individual insurance mandates, and new insurance exchanges for comparison shopping. The ACA also imposes new regulations on medical practices as business entities, as well as changes in the health insurance environment, with accountable care organizations that can manage a continuum of a patient's care across different settings. The ACA created the Federal Center for Medicare and Medicaid Innovation (CMMI), which could result in new payment methodologies such as bundled payments for services. This is a combined meeting with the American Medical Association Ophthalmology Section Council (AMA).