The Affordable Care Act was signed into law on March 23, 2010 by President Obama, with early market reforms taking effect six months later. The report found that the speed at which many states adopted the new provisions of the ACA probably was more dependent upon the schedules of state legislatures. The report also suggested that some states remain cautious about further ACA implementations until the U.S. Supreme Court rules on the constitutionality of the individual mandate. That ruling is expected in June.
The report warns that even though states have until 2014 to fully implement the ACA, some reforms could prove to be more difficult because they are new and don't exist in state law.
"When you look down the road to the 2014 reforms—the bans on underwriting, the guaranteed issue provisions, the new federal subsidies that will be flowing into states along with the Medicaid expansion—these are important changes that states are going to be experiencing in their markets, and also just in terms of their overall fiscal health," Collins says. "These are long-term chronic issues that we have experienced for many years and these provisions really do address some of the serious issue that states have faced."