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President Obama signed health reform into law in March 2010. The Patient Protection & Affordable Care Act is an unprecedented joint federal-state initiative, with provisions to expand health insurance coverage, control costs, and improve the delivery system. This workshop will have as its client one of the states participating in the State Health Reform Assistance Network. We will study federal regulatory process, expansion of Medicaid, development of health insurance exchanges, legal challenges, & Congressional oversight efforts. We will examine implementation through a few states¿ unique political and operational environments.