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JAMA Forum Archive, 2012-2019: Health policy commentary from leaders in the field
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Implementing the Affordable Care Act: Getting the Job Done

Here’s something everyone can agree on in the wake of the Supreme Court ruling on the Affordable Care Act: there will be a lot said on all sides of the issue for the rest of the year.

The question that faces those responsible for implementing the law is: what will get done?

Much work is to be done on the state level, and there has been great variation in how quickly states have taken steps on some key actions, such as setting up health insurance exchanges.

Since the moment President Obama signed the Affordable Care Act, my state, Maryland, has moved forward with deliberate speed. Our state legislature has passed 2 laws establishing and setting a structure for our health insurance exchange. We hired core staff and contracted for the software and the expertise to build the new eligibility, enrollment, and plan selection system. We have held dozens of public meetings, received hundreds of public comments, and resolved many of the key policy issues.

The coming few months are critical to the success of these efforts. Maryland will pick a benchmark insurance plan as the “essential benefits package” in the individual and small group market, set criteria for plans to participate in the insurance exchange, determine a strategy to mitigate risk to avoid an ever-increasing spiral of costs, and establish a strategy for sustainable financing.

If the Affordable Care Act were a symphony, it would require a full orchestra—and plenty of practice.

But the “music” would make this effort worthwhile: affordable health care for hundreds of thousands of Marylanders who desperately need it, help to bend the cost curve and support the economy, and peace of mind for all who have or will develop chronic illness.

Those who are interested in following Maryland’s effort can visit or follow Maryland’s health reform efforts on Twitter at @MDhealthreform and @DrJoshS.

About the author: Joshua M. Sharfstein, MD, is Secretary of the Maryland Department of Health and Mental Hygiene. He has previously served as the Principal Deputy Commissioner of the US Food and Drug Administration and as Commissioner of Health for Baltimore. A pediatrician, he lives with his family in Baltimore.
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