I was excited to come to work today – the first business day of full implementation of the Affordable Care Act. It has been many decades in the making – but the concept that all Americans should have access to affordable health insurance is finally the law of the land. And anti-consumer practices, used by the insurance industry for many years– such as pre-existing condition exclusions – are now a thing of the past.

Over the holidays, the Obama Administration released the latest enrollment numbers showing that approximately 6 million persons have signed up for coverage – 2.1 million through state and the federal marketplace and 3.9 million through Medicaid. SayAhhh! readers will not be surprised that more people have been enrolled in Medicaid than through the Exchange, and this has been long expected by forecasters like the Congressional Budget Office and others for the first year of implementation. However, less seasoned observers may be surprised by the numbers and some who seek to undermine the Affordable Care Act may try to use the numbers to make political hay. But given Medicaid’s long and successful track record (along with CHIP of course!) of reducing the number of uninsured children, and the administrative ease of expanding an existing program rather than raising up a new and complicated system, this really should come as no surprise.

Of course as we all know, the concept of universal health insurance is unfortunately not yet the reality – thanks in large part to the Supreme Court’s ruling rendering the Medicaid expansion optional. Twenty-five states have yet to accept the federal funding – leaving the lowest-income parents and other adults there falling into a coverage gap. Eventually, I believe, all states will move forward but it will take some time.  And there will continue to be some gaps that need to be filled – for immigrant families and those affected by the family glitch, etc.

But like many of you, I have been working on advancing universal coverage for many years now, and the advent of coverage for millions of people today brought a spring to my step as I walked to work this morning. My fervent hope is that as we move forward, a more constructive attitude can prevail, and we can come together as a nation and perfect the Affordable Care Act, so that families can enjoy the peace of mind and access to critical services that health coverage brings.