For these reasons, former Massachusetts Gov. Mitt Romney worked to reform care in his state; subsequently, Mr. Romney's work in Massachusetts created the blueprint for President Barack Obama to create the ACA. The ACA is imperfect and too complicated, but it is an excellent step forward. The ACA has led to millions of Americans now having health insurance, and it has helped to foster "value-based purchasing" — until now, most individuals and employers purchasing care had no idea what they were paying for individual services or whether the services were actually creating more health. With the ACA, the nation is beginning to move toward greater transparency and the incentivizing of care delivery systems that reduce wasteful expenditures while improving the health and satisfaction of our people.