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This 2021 Health Reform Update offers a concise examination of health reform in the United States and a comprehensive look at the key components of the Affordable Care Act (ACA), the ACA under the Trump administration, and the partisan divide in relation to the ACA. It also explores all previous attempts at health reform, as well as the core rulings of multiple U.S. Supreme Court decisions related to the ACA, and key issues going forward. This 2021 update also includes information and updated material related to COVID-19 and its effect on the U.S. health care system.