In 2011 state legislative sessions, lawmakers across the nation in search of common-sense solutions found themselves wrestling with dual challenges on almost every issue: historic budget shortfalls and a charged and starkly changed political climate resulting from an historic wave election in 2010 that saw conservatives take control of 20 new chambers. Both of these factors were front and center on health care measures, as responsible lawmakers joined in the face of these challenges to advance the efficient implementation of the Affordable Care Act, protecting the health security of the most vulnerable and advocating loudly for effective reforms in their statehouses, the courts, and the court of public opinion alike.