In March 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (PPACA), Public Law 1111-148, which if fully implemented will transform health care in the United States. This extremely complex piece of legislation is having an impact on all physicians and hospitals, health insurance companies, and managed care organizations as well as families and individuals. For psychiatry, PPACA includes a number of provisions that reverse dates of discriminatory coverage against the mentally ill. Together with the 2008 Mental Health Parity Law, PPACA expands access to comprehensive, nondiscriminatory mental health coverage to most Americans. In summary, it extends insurance coverage to 32 million more Americans, bars insurance companies from denying coverage based on pre-existing conditions or dropping individuals because of illness, and includes mental health and substance use disorder treatment as part of the basic package of benefits in health insurance sold in state-based insurance exchanges created by the law. These changes (plus a requirement that all insurance ultimately must have full parity for mental health and must include substance disorder treatment) put psychiatry, for the first time, on par with other medical specialty services in the U.S. health care delivery system.