Paul Starr says supporters of reform knew they had to battle to get it passed. Now they need to wage another campaign to implement it:
The reforms will have to be defended in two national elections because the major provisions don’t go into effect until January 2014. Assuming the law survives national efforts to reverse it, its implementation will also depend on complementary action in all 50 states, including many where Republican leaders have been hostile to the changes, questioned their constitutionality, and enacted measures to nullify the federal reforms. Although the federal courts are unlikely to uphold these challenges, the same states may resist fulfilling the substantial responsibilities that fall to them under the law. And even some supportive state governments may find it challenging to carry out their role despite the ample federal money they stand to receive.