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Background on the Implementation of the ACA in the States

In March of 2010, Congress passed and the President signed into law comprehensive health care reform legislation. The new law, called the Patient Protection and Affordable Care Act (ACA), concluded over a year of intense debate on health care reform. Contained in that final legislation were many of ACP’s key priorities related to: expansion of health coverage, payment and delivery system reforms to support primary care, and workforce improvements that will help ensure that all patients have access to an internist.

Since the passage of the ACA last year, much of the attention has shifted to the states as they take steps to implement the provisions of the health reform law. Most states have already begun the process of implementation as numerous guidelines from the federal agencies have been released over the past year – despite legal challenges to the constitutionality of the law.

The ACA presents new opportunities and challenges for states in providing access to health care services for their residents. In implementing various provisions of the law, states can take advantage of opportunities to improve quality and reduce costs. In turn, chapters can influence issues that play-out on the state level, such as medical liability reform (including caps on damages and “health courts”), physician reimbursement rates, and public health issues, to name a few. The challenge for states is how to implement the ACA at a time when most states are in the midst of a budget shortfall. As a result of these perceived opportunities and challenges, state governments will want to seek stakeholders’ feedback on how best to implement the ACA. With this comes the opportunity for our chapters to try to influence the development of new health care policies in their state in ways that advance ACP’s priorities and ensure that the needs of physicians and their patients are met.

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