Objectives To provide an overview of key elements of the Affordable Care Act (ACA). To evaluate ways in which the ACA will likely impact the practice of critical care medicine. To describe strategies that may help health systems and providers effectively adapt to changes brought about by the ACA. Data Sources and Synthesis Data sources for this concise review include search results from the PubMed and Embase databases, as well as sources relevant to public policy such as the text of the Patient Protection and Affordable Care Act and reports of the Congressional Budget Office (CBO). As all of the ACA's provisions will not be fully implemented until 2019, we also drew upon cost, population and utilization projections as well as the experience of existing state-based healthcare reforms. Conclusion The ACA represents the furthest reaching regulatory changes in the US healthcare system since the 1965 Medicare and Medicaid provisions of the Social Security Act. The ACA aims to expand health insurance coverage to millions of Americans and place an emphasis on quality and cost-effectiveness of care. From models which link pay and performance to those which center on episodic care, the ACA outlines sweeping changes to health systems, reimbursement structures, and the delivery of critical care. Staffing models that include daily rounding by an intensivist, palliative care integration, and expansion of the role of telemedicine in areas where intensivists are inaccessible are potential strategies that may improve quality and profitability of ICU care in the post-ACA era.