A longstanding leader in private- and public-sector health reform, Minnesota is making remarkable progress implementing the Patient Protection and Affordable Care Act (ACA), despite a challenging political environment. The states ability to accomplish as much as it has including the creation of two task forces, securing multiple grants to support different pieces of ACA implementation, adopting the early Medicaid expansion, implementing early insurance reforms, and taking vigorous steps toward building an effective Exchange in time to meet challenging federal deadlines testifies to remarkable collaboration between multiple state agencies and stakeholders in transforming the states health system.