Perspective:

The Affordable Care Act (ACA), enacted in 2010 and upheld as constitutional by the US Supreme Court on June 28, 2012, has survived a series of life-threatening obstacles since its congressional consideration began in mid-2009. The Obama administration is now trying to implement the ACA as quickly and thoroughly as possible, working to establish infrastructure, rules, and relationships in one of the most complex and multifaceted statutory implementations ever. The ACA is the first US law to attempt comprehensive reform, touching nearly every aspect of our health system. The law addresses far more than coverage, including health system quality and efficiency, prevention and wellness, the health care workforce, fraud and abuse, long-term care, biopharmaceuticals, elder abuse and neglect, the Indian Health Service, and other matters. In a less contentious political environment, Democrats and Republicans would collaborate in assessing, modifying, and reconstructing many ACA elements, typical activities after the launch of any major law. And we may still get there as the Supreme Court ruling and the dust from the November elections settles. There remain many obstacles ahead.