As the Patient Protection and Affordable Care Act marks a big milestone (it turned 5 on March 23), we look back on the law's biggest moments, movers and motives.

1. Supreme Court case on the law's constitutionality (March 2012)

The Patient Protection and Affordable Care Act didn't have to wait long for a big, big moment: Just two years after being signed into law, it went to the Supreme Court in a big way. The court announced it would hear a case about the law's constitutionality after 26 states—led by Florida—sued the government over the law's linchpin, the individual mandate, arguing individuals couldn't be forced to buy insurance. The court heard three days of politically charged arguments March 26–28 over the constitutionality of PPACA. It was a case that divided the nation.

Ultimately, we know what happened: On June 28, 2012, the Court upheld the individual mandate as a tax by a 5-4 vote, but it left Medicaid expansion up to the states.

2. Disastrous HealthCare.gov rollout (October 2013)

The Oct. 1, 2013, launch of PPACA's federal exchange, Healthcare.gov, was a hugely anticipated moment for PPACA. But it (hugely) failed to meet expectations.

HealthCare.gov was plagued with so many technical problems upon its launch—first and foremost the website's inability to manage a heavy use load—that Congress decided to hold hearings about it later that month. Early enrollment numbers were far fewer than hoped or anticipated, partly because enrollees were unable to stay on the site long enough to sign up.

Though in its second enrollment period Healthcare.gov still suffered from a number of glitches, it performed much better than during its first year.

3. Kathleen Sebelius's resignation (April 2014)

Teacher's/President's Pet: Kathleen Sebelius

The resignation of Health and Human Services Secretary Kathleen Sebelius closed a major chapter in Obamacare. She resigned just as PPACA topped its first-year enrollment goal.

The secretary of five years was one of the major PPACA players from the beginning: She made a career out of praising, touting and defending the Patient Protection and Affordable Care Act. She announced the law's milestones, and her achievements were directly tied to PPACA's: expanded health care coverage, the elimination of pre-existing condition denial by carriers, and expanded Medicaid.

But she also endured backlash over the administration's PPACA delays, answered questions about concerns over the law and even testified about it. And when HealthCare.gov suffered a disastrous rollout, she took the blame.

Sylvia Mathews Burwell, former director of the Office of Management and Budget, took over as HHS secretary in June 2014.

4. The employer mandate delays

Though a number of the law's components have been delayed over the years, the one with the most backlash was PPACA's employer mandate—which became a lightning rod for criticism of the law.

The provision—once thought of as a key, if not essential, part of PPACA—since its inception has been vehemently attacked by employer groups and business owners. Originally scheduled to go into effect in 2014, the mandate was twice delayed by the administration, which said it needed more time to implement the provision. Those delays called into question whether the provision would ever be implemented, and whether the provision was even needed in the law.

Attention to the mandate hit a new high at the Benefits Selling Expo in April 2014, when Robert Gibbs predicted during a keynote address that the employer mandate would never be put into effect.

“I don't think the employer mandate will go into effect. It's a small part of the law. I think it will be one of the first things to go,” he said to a notably surprised audience.

Gibbs was proven wrong when the updated January 2015 deadline stuck for employers with more than 100 employees, who had either to offer insurance or pay a fine of $2,000 per worker. Meanwhile, employers with between 50 and 99 employees have until January 2016 to offer health insurance or pay a fine. Companies with fewer than 50 employees are exempt.

5. Most likely to succeed: The dropping uninsured rate

Subsidies challenge

In late 2014, it was announced that once again the Supreme Court would hear an important PPACA case, this one on the federal subsidies under the law.

The case ultimately hinges on just four words—“established by the state”—as it calls into question the legality of federal exchanges. While PPACA challengers say that phrase limits the tax credits to the 16 states that have set up their own exchanges, the Obama administration has defended an IRS rule that interpreted the law as allowing subsidies nationwide.

Of course the decision has huge implications. Ruling the subsidies invalid could unravel the Patient Protection and Affordable Care Act, making other core provisions ineffective and potentially causing the market for individual insurance policies to collapse. And, invalidating the subsidies, analysis finds, could boot nearly 10 million from health coverage and cause crushing premium increases for millions more.

The Supreme Court heard oral arguments on the case, King v. Burwell, March 4. It is expected to make a decision by June.

Most likely to: embarrass the Obama administration

Jonathan Gruber

“Call it the stupidity of the American voter or whatever, but basically that was really, really critical to get for the thing to pass.”

— Obamacare architect Gruber on how Democrats in Congress passed PPACA

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