The Patient Protection and Affordable Care Act (ACA) uses competing private health plans to expand coverage and promote better value. The reform generally operates by creating new options for coverage, along with incentives and information, rather than by imposing direct controls on the economy or personal behavior. The ACA thus expands rather than curtails personal choice and autonomy, especially for the uninsured and people whose employers offer just one plan. After the ACA, as before, the vast majority of Americans under Medicare age will receive private insurance and obtain care from private physicians and hospitals.