The most important coverage provisions of the Affordable Care Act (ACA) were implemented on January 1, 2014. The law gives states the option of expanding Medicaid to those with incomes up to 138 percent of the federal poverty level (FPL). It also establishes health insurance Marketplaces and provides income-related subsidies that make coverage purchasing easier and more affordable for individuals and small businesses. Finally, the ACA requires employers with more than 50 workers to contribute to health coverage for their employees or face a penalty, and imposes a mandate on individuals to obtain coverage. Because of these provisions, the ACA is expected to expand insurance coverage, improve access to health care, and make health care more affordable. In this brief, we assess the potential gains in access and affordability by examining differences among adults with different types of insurance before health reform implementation.