Only 11 states and DC have passed laws or issued regulations to implement the Affordable Care Act’s major reforms that go into effect in 2014 — including bans on denying health insurance due to preexisting conditions, minimum benefit standards, and limits on out-of-pocket costs. Thirty-nine states have not yet taken action to implement these requirements, potentially limiting their ability to fully enforce the new reforms and ensure that consumers receive the full protections of the law.