The ten states participating in the Robert Wood Johnson Foundation's monitoring and tracking project have taken significant steps to implement the early market reforms of the ACA. Each state took action to require or encourage insurers to comply with these reforms. Although some challenges were noted, insurers are generally complying with them; regulators are hearing few consumer concerns, and premiums have not risen substantially because of these reforms. Compliance was largely facilitated through the efforts of state regulators, insurers, and consumer advocates. The actions taken by these states reflect the diversity of approaches that exist among states nationwide.
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