It is often said that it is the journey, not the destination, that matters most. When it comes to health care reform, it is both. The destination, as framed by the Patient Protection and Affordable Care Act (ACA), is affordable health insurance coverage and improved access to care. The journey will require setting up marketplaces (exchanges), selling qualified insurance, expanding Medicaid, and transforming payment and delivery systems. Before President Obama's reelection, one could have envisioned the journey being halted, but over the next 4 years, the health care system will have to travel a road to reform over political and practical obstacles, all of which will directly affect physicians and their patients.