What is your states responsibility in preparation for healthcare change such as the ACA

The Trade-Off Analysis
In considering healthcare system trade-offs politics plays a major role. Understanding the strengths and weaknesses of the current Medicaid system in the United States based on individual state policies is important to the political and legal platforms each state faces. As organizations seek to implement HMIS and IT program development upgrades and evaluations the organizations must be capable of separating the IT failures budget overruns and exogenous changes in enrollment that affect the healthcare system. In a minimum of 250 words discuss the following:
Who is responsible on the state political level to propose legislature to overcome healthcare organizations concerns (trade-off) relating to patient enrollment and budget overruns
What is your states responsibility in preparation for healthcare change such as the ACA
How do healthcare leaders best integrate pre-existing conditions and long-term illness