The federal reform legislation known collectively as the Affordable Care Act (ACA) has a lofty goal: to transform the way health care is provided and paid for in the United States. Sweeping in scope, with an implementation timeline that spans nearly a decade, the new law will fundamentally alter the availability and structure of health insurance, bringing coverage for the first time to millions of Americans and creating new coverage options for millions more. Federal estimates indicate that 92 percent of the people not yet eligible for Medicare could have access to coverage by 2016, compared to 81 percent today.

The implementation of these reforms will be a massive undertaking requiring leadership, interagency and public-private collaboration, and a disciplined and aggressive planning process. Although the policy and legislation were crafted at the national level, their successful execution depends, in large part, on the actions taken within the states, with much of the responsibility falling to state government.