The U.S. Supreme Court's ruling last month upholding the Patient Protection and Affordable Care Act resolved constitutional questions about the sweeping law. Now states are left with the challenge of implementing it.
And reports show a huge variance in readiness from state to state, particularly as it relates to health insurance exchanges.
Hunt says the biggest challenge for most states is deciding "how active they want to be in the health insurance market and if they want to be active how to do that in a way that makes the whole insurance market work," she says. "There are some important decisions to make in terms of how active the states want to be, if they just want to allow the health plans to offer whatever plans they want, or if they want to guide the market to more delivery system reform."