With the inauguration of President Biden and a shift in control of the US Senate from Republicans to Democrats, the landscape for health policy has changed substantially in 2021. Just as the signing of the Affordable Care Act (ACA) by President Obama in 2010, along with sustained Republican opposition to this landmark law, set the health policy agenda for the past decade, the actions of the new president and Congress this year will determine how the US health care system functions and changes over the next decade.