Implementing Health Reform at the State Level

The Affordable Care Act (ACA) promises to improve access to coverage and care for two vulnerable groups: low-income persons who are excluded by a lack of resources, and chronically ill and disabled people who are excluded by the dysfunction of our existing insurance and care delivery systems. ACA's sprawling provisions raise a wealth of implementation challenges that are exacerbated by the compromises required to move reform through Congress. In particular, the compromise between regulatory/public program advocates and advocates for private, market-driven programs requires thoughtful regulatory coordination between public and private health systems.