The Affordable Care Act includes numerous consumer protections designed to improve the accessibility, adequacy, and affordability of private health insurance. Because states are the primary regulators of health insurance, this issue brief examines new state action on a subset of protections—such as guaranteed access to coverage and a ban on preexisting condition exclusions—that go into effect in 2014. The analysis finds that, to date, only one state passed new legislation on all of these protections, and an additional 10 states and the District of Columbia passed new legislation or issued a new regulation on at least one protection. The analysis also finds that—without new legislation—some states face limitations in fully enforcing these reforms. These findings suggest an acute need for states to take action in 2013 to help ensure that consumers are fully protected by and benefit from the Affordable Care Act’s most significant reforms.