The 111th Congress is gone but not forgotten, having passed into law the landmark Affordable Care Act of 2010. Although this legislation has several interesting appropriations for cancer research, a core principle of the bill is finding ways to reduce health-care spending, which gives the oncology community an uneasy sense of déjà vu: The Medicare Modernization Act of 2003 hammered oncology with deep cuts in reimbursement for Part B drugs, leaving many community infusion centers underwater. Oncology practices, especially smaller one- to three-person groups, have to wonder how much more change they can take.