Overhaul rx: lawmakers have plenty of work ahead to comply with the new federal health care law.

• Author: Brand, Rachel

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Concerned. Excited. Digging in.

As the spotlight on the overhaul of the health system shifts to the states, legislators are preparing for the largest transformation of health care in 30 years.

"We are overwhelmed, but so are the feds," says Representative Peggy Welch of Indiana. "We are all in this together, and we all want to be successful."

Even if your state's attorney general is arguing the new law is unconstitutional, she says, legislators need to move ahead.

Massachusetts Senator Richard Moore, whose state provided a model for health care change, offers this advice: "State lawmakers need to start planning now. It's going to take time for it all to roll out. We should begin to listen and find reliable sources of information."

The $960 billion federal health law aims to expand coverage to 32 million more Americans. It relies on a combination of Medicaid expansions, subsidies, tax credits and mandates. The law also allocates money to improve quality and halts certain widely criticized insurance practices.

The biggest changes come in 2014 when Medicaid expands and states create exchanges or marketplaces for health insurance. But first there's much to do this year.

In recent months, legislators have been traveling to Washington to voice concerns and get clarification about state responsibilities. This summer, some states will convene councils, agencies and commissions to plan and coordinate implementation. In July, new state high-risk pools will open. By September, state regulators will enforce tighter insurance regulations.

"The new federal health care legislation has a whole lot of regulatory discretion," says Utah House Speaker Dave Clark. "In that void, it's going to be necessary for states to have their voices heard collectively in Washington. States have a tremendous opportunity to assert themselves."

In Colorado, for instance, the health system changes touch 10 state agencies. Policymakers--with no new money,ave formed an implementation council.

"State officials need to figure out where they have talent and resources to do some of the planning," says Joan Henneberry, Colorado's executive director of the Department of Health Care Policy and Financing. "Since they haven't gotten any new federal funds, they should do a quick environmental scan to find people on state payroll who have a talent for this stuff.

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"Then you need to develop a coordinated response. It will be a disaster if you go about it willy-nilly."

Finally, the federal changes provide a laundry list of competitive grants and funding to help states set up consumer assistance offices, review insurers' rate hikes, support home nurse visits to high-risk pregnant women, and provide sex education and abstinence programs, among other things. Plus, the feds have...