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The Patient Protection and Affordable Care Act of 2010 revealed important ideological and partisan conflicts between Democrats and Republicans. These conflicts still persist four years after the enactment of the Law. This article analyses the manifestations of this partisan polarization of health care issues. It focuses on policymaking and reform processes that have been increasingly driven by party logic over the last twenty years or so, and considers the consequences of this dynamic on the direction of US health care policy. Emphasising the rapid pace of reform, both more frequent and more structural since the 1990s, the article argues that the increased weight of party logic within the policy-making process goes some way to explaining the direction these policies have taken.