(ACA) became law in January 2014, no one could accurately predict its impact. Now that the law has been in effect for nearly a year, enough data is available to assess the early results and examine the effect on patient responsibility, which is the amount that a patient owes on healthcare services rendered, excluding insurance payments. Are hospitals seeing more insured patients than they saw prior to January 2014? Has patient responsibility increased or decreased? How does each state’s decision about whether to expand Medicaid have an impact on the ACA’s stated goal of insuring more low-income Americans?