While the Affordable Care Act (ACA) primarily focused on expanding coverage to many of the 46 million uninsured Americans at the time, it included various provisions that sought to slow the growth of health care spending. In an LDI Issue Brief two years ago, we looked at how the ACA provisions affected costs through 2015. We found little evidence that they had produced the changes necessary to “bend the cost curve,” although the double-digit growth rates of the 2000s had not returned. However, it is possible that the ACA’s changes have had more cumulative effects. This brief updates our earlier piece, and assesses the effects of the ACA on costs since its passage 10 years ago.