Top-of-the-mind health care topics in states are Medicaid and implementation of the federal Affordable Care Act. Medicaid enrollment continues to grow, federal stimulus funds have disappeared, and in many states providers are pressuring for increased reimbursement. States also must grapple with complying with mandates in the federal Affordable Care Act. The U.S. Supreme Court is expected to rule on the constitutionality of the law sometime in 2012. In the meantime, states must decide how far to go in their own implementation.