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The Patient Protection and Affordable Care Act' ("ACA") has, as its primary goal, universal access to health insurance for all American citizens and legal residents. When fully implemented, the ACA will provide insurance to an additional 32 million people who are currently uninsured and to many millions of others who are underinsured. While universal health insurance is certainly a public health goal that this country has sought for many decades, the additional lives that will be added to the insurance rolls as well as new minimum coverage requirements mandated by the ACA will create fiscal burdens for the already expensive U.S. healthcare system. In 2009, Americans spent $2.5 trillion or 17.6 percent of gross domestic product ("GDP") on health care, a number that is predicted to continue to rise absent serious interventions. The ever-escalating costs of health care as well as the anticipated costs of healthcare reform for the additional 32 million Americans who will be required to have health insurance by 2014 may well prove to be a crucial tipping point for an already fiscally overblown healthcare system.