President Barack Obama will remain in the White House for the next four years, which means the Affordable Care Act (ACA), the biggest accomplishment of his first term, will continue to be implemented. The first item on the Obama Administration’s healthcare agenda is establishing state insurance exchanges across the nation. The ACA requires states to implement health exchanges by January 1, 2014, with open enrollment occurring on October 1, 2013. So far 13 states and the District of Columbia have enacted legislation to establish an ACA-compliant insurance exchange that offers subsidized coverage from private insurers. Other states, such as Texas and Louisiana, held off on creating exchanges in hopes that Mitt Romney would win the election and follow through with his promise to repeal the healthcare law. That didn’t happen, and now the clock is ticking. States must notify the federal government if they plan to set up an insurance exchange by November 16. If states opt against creating an exchange, the federal government will step in and do it for them. However, it seems clear that even states that choose to establish exchanges will not be ready by the 2014 deadline. Illinois officials are currently reviewing bids to build the state’s health insurance exchange. Officials say their state-run exchange will not be ready until 2015. Illinois will partner with the federal government to run its exchange in 2014. Still some are skeptical that even the federal government will be ready by 2014. In an interview with Kaiser Health News, Paul Ginsburg, president of the Center for Studying Health System Change asked, “What is the state of readiness to implement both state insurance exchanges and the federal backup? The administration has been extremely silent about this.” The Department of Health and Human Services (HHS) has delayed publishing exchange-related regulations, raising the question of whether it will be prepared to create exchanges for all the remaining states. Perhaps now that the election is over, HHS and the Obama administration will publish some of the long-awaited regulations that will detail their plans for establishing a federal insurance exchange. Many experts are predicting a “flood” of healthcare reform rules now that the president has secured a second term. If not, is there a possibility that the implementation date will be pushed back?