The Affordable Care Act (ACA) (full title: The Patient Protection and Affordable Care Act) (P.L. 111-148) will generate sweeping changes in the financing, organization, and accessibility of health and social services in the United States. The expansion of Medicaid and the establishment of state health insurance exchanges (HIEs) will vastly expand insurance access in the United States, with an estimated 30 million Americans gaining coverage (Banthin et al., 2012). The emphasis on integrated models of care, including patient-centered medical homes and accountable care organizations, introduces new opportunities to improve care coordination, reduce unnecessary service use, and make health care more cost-effective. Realizing these changes relies on the work of many health care professions. In this editorial, we make a case for how the social work profession can forge a leadership role in implementing this historic legislation.