The Patient Protection and Affordable Care Act, also known as the Affordable Care Act (ACA) or informally referred to as Obamacare, is a United States federal statute signed into law by President Barack Obama on March 23, 2010. On June 28, 2012, the Supreme Court upheld the constitutionality of much of PPACA. ACA represents the most significant regulatory overhaul of the U.S. healthcare system since the passage of Medicare and Medicaid in 1965. ACA is aimed primarily at decreasing the number of uninsured Americans and reducing the overall costs of health care. It provides a number of incentives, including subsidies, tax credits, and fees to employers and uninsured individuals in order to increase insurance coverage. Additional reforms are aimed at improving healthcare outcomes in the United States while updating and streamlining the delivery of health care. ACA requires insurance companies to cover all applicants and offer the same rates regardless of pre-existing conditions or gender.