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The Patient Protection and Affordable Care Act isn’t as old as you think, but its history has already been long and arduous. Three years after President Obama signed it into law, it’s still overwhelmingly confusing—not to mention unpopular—among Americans across all demographics.

Sure, the law survived a Supreme Court case and a presidential election, but it hardly escaped unscathed. Many more states than expected refused to set up their own health care exchanges, instead defaulting to the federal government. House Republicans are still holding votes to repeal PPACA, though the motion isn’t likely to make it past the Democratic Senate. Carriers are proceeding with caution when it comes to setting up shop in the public exchanges while industry veterans warn of impending doom.

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