Bill number HR 3962 became law when it passed the House of Representatives and the Senate. Since President Obama signed it on March 23, 2010, the Patient Protection and Affordable Care Act has been the subject of multiple lawsuits challenging its constitutionality. Republicans in the House of Representatives have tried more than 40 times to repeal the Affordable Care Act since it went into effect (each effort has failed in the Senate) [source: Graves]. According to the law, every American is required to buy health insurance, and every state is required to set up a health insurance exchange for them to do so. The U.S. Supreme Court upheld the law's constitutionality in 2012, but that didn't end the debate. In 2013, for example, a D.C. Circuit Court judge (among other federal courts) concluded the act's requirement for employers who provide group insurance to provide birth control at no additional charge impedes on the religious freedoms of private-sector employers who oppose contraception, under the Religious Freedom Restoration Act. That opens the door to another Supreme Court review.