After years of waiting the Affordable Care Act has finally gone live. The law is not working nearly as well as Democrats once planned because of Republican-controlled states opting out of Medicaid expansion and problems with the new exchanges, but there are still millions of people who now have new health insurance coverage as a result.

Roughly 2 million people have selected plans on the health insurance exchanges and another 4 million new people are going to get coverage via Medicaid or CHIP.

It is no longer merely a law, a point of political debate, or a ideological football. It is now reality for millions. It is the new status quo.

Any plan to reform our health care system will need to deal with the existence of the ACA with all the winners and losers it has now created. As of today it is another misshapen piece firmly embedded in our overpriced patchwork health care system.

Photo by José Goulão under Creative Commons license