Before these two events, the viability of the Act was significantly in question. Conservatives believed that Justice Roberts would lead a divided court into ruling the Act unconstitutional, and Republicans believed that with Mitt Romney in the White House the Act would be appealed in short order. Given those uncertainties, many health care providers, as well as those States with Republican leadership, took a wait-and-see approach, hoping that accountable care organizations, health exchanges and insurance overhauls would be avoided.

As everyone knows, the Supreme Court upheld the Affordable Care Act. Thereafter, with the re-election of President Obama, the waiting game ended and the largest overhaul of the U.S. health care system became a certainty. And so, providers and States now face the daunting task of preparing themselves for the full impact of the Affordable Care Act, although many Republican Governors continue to take a position of defiance with hopes that Congress and the President will make concessions. With this back-drop in mind, following are my top 10 health care developments for 2012.