“Since passage of the Affordable Care Act (ACA), the American Action Forum (AAF) has tracked the state of its regulatory implementation. To date, the ACA has imposed a total of $27.6 billion in new regulations – at least $20.4 billion in lifetime costs on private entities and $7.2 billion in increased burdens on state budgets. In this paper AAF examines how this $27.6 billion in new costs break down on a state-by-state level. The data show that five states will endure at least $1 billion in ACA regulatory costs.”