A three-article special section on health care reform and mental illness constitutes "a primer for mental health clinicians and policy makers," notes Thomas G. McGuire, Ph.D., guest editor of the special section. In his introduction to these articles (page 1073), he also notes that the Patient Protection and Affordable Care Act (PPACA) "primarily reforms health insurance, not health care." Indeed, the first two articles focus on provisions of the law that will expand insurance coverage. Many Americans will purchase private insurance through newly created state-based "exchanges" that consolidate and regulate the marketplace for individual and small-group plans. In the first article, Dr. McGuire and Anna D. Sinaiko, Ph.D., discuss ways to structure an exchange to ensure that it will serve people with mental illness fairly and efficiently. They describe the experience of people with mental illness in insurance markets similar to exchanges, such as the Massachusetts Connector. The authors recommend approaches to regulating pricing, enrollment, and consumer choice and emphasize the important role of the exchange authority in each state (page 1074). In the second article, Rachel L. Garfield, Ph.D., M.H.S., and colleagues highlight likely gaps in the insurance coverage that will be offered under health reform to people with mental illnesses or substance use disorders through private plans and public programs. They describe policy options to address these gaps and to ensure that a full range of services and supports is covered (page 1081). In the third article, Benjamin G. Druss, M.D., M.P.H., and Barbara J. Mauer, M.S.W., C.M.C., describe opportunities afforded by reform for improving the delivery of care at the interface between behavioral health care and primary care, including patient-centered medical homes and colocation of services. They focus on key supports needed to ensure success of these initiatives: new financing mechanisms, quality assessment metrics, information technology infrastructure, and technical support (page 1087). In a Taking Issue commentary Vidhya Alakeson, M.Sc., and Richard G. Frank, Ph.D., note that even though the PPACA places behavioral health squarely in the health care mainstream, policy makers must redouble their commitments to address the "sometimes exceptional circumstances presented by mental health care delivery" (page 1063). In an Open Forum, Neil Krishan Aggarwal, M.D., M.B.A., and colleagues describe elements of the PPACA that posit seemingly contradictory views of health care: is it a commodity or a right, and what implications are inherent in these two views (page 1144)?