Eight years after passage of former President Barack Obama’s landmark health reform law, the Patient Protection and Affordable Care Act (ACA) continues to face significant political, legal and economic challenges. The ACA — dubbed “Obamacare” — has expanded access to health services to millions of Americans, cut the uninsured rate in half and spurred efforts to improve the quality of care. But its Republican critics say it is expensive, unconstitutional and harmful to consumers. With Congress in 2017 unable to agree on whether to repeal or replace the ACA, the Trump administration began taking a number of regulatory steps to kill the law. The outcome of the November midterm elections, health analysts say, is likely to play a big role in whether the ACA survives.