The Patient Protection and Affordable Care Act is an American law passed in March of 2010. Its primary goal is to achieve universal health insurance coverage by facilitating cooperation among employers, citizens, and the government. Its other objectives are to make healthcare more affordable while simultaneously increasing healthcare quality and reducing unnecessary spending. To this end, the Act puts specific emphasis on primary and preventative care. The Act requires that all US citizens and legal residents purchase health insurance to increase the pool of healthy individuals enrolled. This "individual mandate" spreads around the associated risk while subsidizing coverage for the economically disadvantaged. It potentially includes an expansion of Medicaid, at the discretion of the state governments. Additionally, the Act promotes the creation of state health insurance "Exchanges" that allow employers and individuals to select health insurance options that are eligible for federal subsidies in accordance with state and federal regulations. Subsidized plans that meet these requirements are called "qualified health benefit plans." To achieve universal coverage, the Act also bars insurance companies from refusing coverage to those under 19 years of age with pre-existing conditions, prohibits cost ceilings on essential health benefits, and allows children less than 26 years of age to stay on their parents' health insurance plans. In an effort to more thoroughly integrate employers into the program and promote preventative care, the Act incentivizes the creation of "wellness programs" in the workplace by offering discounts, rebates, and waivers towards the cost of insurance.