The Commander in Chief has shown his influence over the health care system through his pioneering of the most significant health care reform legislation in decades. But his leadership will face even sterner tests in 2011 on both the legislative and judicial fronts. After a Virginia court decision said it is unconstitutional to require individuals to purchase medical coverage, 20 other states lined up behind similar challenges to PPACA. And in dealing with the new Congress, Obama will again need to explore compromises in adjusting the law, especially with newly empowered members of the GOP who dont wish to be seen as compromising. All will test the powers of Obamas persuasion. Just before the new Patient Protection and Affordable Care Act was signed into law, President Obama underlined the legislations significance. Is this the single most important step that we have taken on health care since Medicare? Absolutely. Is this the most important piece of domestic legislation in terms of giving a break to hardworking middle class families out there since Medicare? Absolutely. Is this a vast improvement over the status quo? Absolutely, he said.