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The question of whether the Affordable Care Act (ACA) will lead to job loss was revisited in the first presidential debate. This brief summarizes what would be expected based on economic theory and the evidence under health reform in Massachusetts, the template for the ACA. Employment trends in Massachusetts closely mirrored those of the rest of the nation in the periods before and after reform, while gross domestic product grew at a faster rate than in the rest of the nation after reform. The evidence suggests that the ACA will have little effect on employment and may support stronger economic growth.