Actions needed in most states to implement ACA’s 2014 market reforms: The Affordable Care Act (ACA) includes numerous consumer protections designed to improve the accessibility, adequacy, and affordability of private health insurance. These reforms will phase in over time, with the most dramatic changes scheduled to take effect in 2014. These changes—known as the “2014 market reforms”—include such provisions as guaranteed access to coverage, a ban on preexisting condition exclusions, restrictions on the use of health status and other factors when setting premium rates, and coverage of a minimum set of essential health benefits. Under the ACA, states are the primary regulators of health insurance and will be key players in enforcing these protections. To understand states’ progress in implementing the ACA, the Commonwealth Fund conducted an analysis of new actions taken by states from January 2010 to October 2012 to implement or enforce seven of the most critical 2014 market reforms. The analysis found that only one state (Connecticut) passed new legislation on all seven protections. An additional ten states and the District of Columbia passed new legislation or issued a new regulation on at least one of the seven protections. Thirty-nine states have yet to take new actions to implement the 2014 market reforms. These findings suggest an acute need for states to take steps in 2013 to help ensure that consumers are fully protected by and benefit from the ACA’s most significant reforms. The 14-page issue brief, Implementing the Affordable Care Act: State Action on the 2014 Market Reforms, is available at www.commonwealthfund.org.