The Patient Protection and Affordable Care Act has been the topic of heated political debate since becoming the law of the land almost one year ago. As right-wing calls for repeal continue to make headlines, many positive and popular provisions of the law are already benefiting families across the nation. Working-class and middle- class families have seen their health security increased by provisions that rein in insurance industry abuses and expand coverage, making it less likely that they will lose their savings due to an illness or injury, or be unable to afford needed treatments.

But as the curtain draws on the first year of the life of the Affordable Care Act, what happens in the second year at the state level may prove to be even more critical to its ultimate fate.

In 2011, the shape of the most prominent piece of the law -- and the health security and economic security of American families for decades to come -- will be decided in statehouses across the nation. This legislative session, states have a once-in-a-generation opportunity to put consumer protections and stronger access to affordable health care coverage in the hands of their residents.

Under the health law enacted in March 2010, states are tasked with setting up health care "exchanges," or marketplaces that will create new incentives for the health insurance industry to deliver quality care at lower prices. Exchanges will require insurance companies to spend more of consumers’ premium dollars on actually providing health care -- instead of bloated administrative overhead and egregious compensation for CEOs.

As part of our 2011 Blueprint for Economic Security, Progressive States Network has compiled an overview of how to Enact a Progressive State Exchange this session, including a focus on key legislative elements of a strong exchange such as determining the Governance of the health exchange and creating a Board Structure that will ensure a strong governing body, as well as a set of Next Steps for creating a strong exchange.

Under the timeline set out in the Affordable Care Act, state exchanges are scheduled to begin operating in 2014 -- but every state legislature must act this session to pass a strong version of an exchange in their state if they do not want the federal government to run their exchange. By implementing a strong exchange, states can allow the uninsured, self-employed and small businesses to shop for insurance in a competitive marketplace, giving consumers greater control and power through information and choice.


ACA Timeline

This link to's time line for the Affordable Care Act provides an interactive tool to show and explain what provisions take effect and when.  It outlines a comprehensive analysis of the federal law.