FROM THE MID-1960s TO THE EARLY 1990s, BOTH HEALTH CARE inflation and the number of people without coverage grew dramatically in the U.S., particularly in comparison to other western industrialized nations with universal coverage. At the root of these problems was the nation’s failure to regulate health care costs. Health care inflation continues to plague the U.S. health care system and was one of the driving forces behind enactment of the Affordable Care Act (2010) under the Obama administration. This chapter provides an overview of private insurance, managed care, the inflationary nature of health care in the U.S., and efforts to contain the escalating cost of providing health care in the U.S. through the Affordable Care Act (ACA). It also examines the impact of the Trump administration’s efforts to “repeal and replace” the ACA on cost. The length of this chapter reflects the extent of the problem of health care inflation in the U.S. health care system; it includes a history of past efforts to contain costs and the continuing need for significant reforms.