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The Affordable Care Act was enacted by Congress, signed into law by President Obama, and upheld against constitutional challenge by the United States Supreme Court. Under the Constitution, it is the supreme law of the land. The efforts of radical Republicans to "defund" the law will not prevent its implementation, which will proceed by voluntary subscription, or by involuntary tax assessment. To change this, Congress would have to repeal the act; which, by counting votes, is not likely to happen any time soon. So, better get used to it.