Just in the time for this week's one year anniversary of the passage of the Affordable Care Act, a new study by the Commonwealth Fund revealed that the new health care reform law's full implementation can't come soon enough. Since the start of the recession, almost 60% of Americans who lost a job and their health insurance- 9 million people - could not afford to regain coverage. Medical costs pushed four million more into bankruptcy. Mercifully, as the analysis also showed, "When fully implemented in 2014, the Affordable Care Act will bring relief: nearly all of the 52 million working-age adults who were without health insurance for a time in 2010 will be covered."

The Commonwealth Fund report ("Help on the Horizon: How the Recession Has Left Millions of Workers Without Health Insurance, and How Health Reform Will Bring Relief") sums up the bleak present and hopeful future of the American health care system.

Its 2010 Biennial Health Insurance Survey of over 3,000 adults ages 19-64 highlighted the devastating toll of the Bush recession which started in December 2007.

The survey finds that both insured adults--who are facing higher premiums and out-of-pocket costs--and uninsured adults cannot afford adequate health care. Seventy-five million adults did not get needed health care in 2010, skipping doctor visits, prescriptions, specialist care, and recommended tests and treatments because of costs. This represents a 60 percent increase from 2001, when 47 million people reported skipping needed care because of costs. Uninsured adults were the most likely to forgo care because of costs, with 66 percent reporting they did so. However, many insured adults were also less insulated from high health care costs--31 percent of adults who were insured all year went without the health care they needed because of costs, up from 21 percent in 2001.

Likewise, 73 million people reported problems paying their medical bills or were paying off medical debt, up from 58 million in 2005. The survey finds that because of medical bills, an estimated 29 million people spent all of their savings, 17 million incurred credit card debt, 22 million were unable to pay for basic necessities like food, heat, and rent, and 4 million declared bankruptcy.

All told, "Nearly three of 10 (28%) working-age adults, an estimated 52 million people, were uninsured for at least some time during 2010, up from 38 million or 24 percent in 2001." Those with incomes below the Federal Poverty Line (FPL) fared much worse, with 54% going without coverage at some point last year, compared to 13% among families living at twice the poverty level.

But as the Commonwealth Fund President Karen Davis explained last week, the new consumer protections, insurance requirements and government subsidies contained in the health care reform law signed by President Obama last March will help ensure that nearly everyone, including the jobless, has access to comprehensive coverage by 2014:

"The silver lining is that the Patient Protection and Affordable Care Act has already begun to bring relief to families," she said. "Once the new law is fully implemented, we can be confident that no future recession will have the power to strip so many Americans of their health security."

As the Fund's analysis showed, thanks to Affordable Care Act the vast majority of the 52 million adults lacking health insurance in 2010 will gain coverage beginning in 2014. Millions more will benefit as their ability to absorb the price of annual premiums and out of pocket costs improves.

But even short of the total Congressional repeal of the 2010 health care bill, Republican states are taking actions that threaten the law's implementation now and into the future. In Pennsylvania, new GOP Governor Tom Corbett is slashing the Keystone State's health funding for low income funding. After just weeks in office in Wisconsin, Republican Governor Scott Walker erased months of progress by his Democratic predecessor by "dissolving the health reform office and replacing it with the Office of Free Market Health Care." Meanwhile, 26 states - virtually all governed by Republicans and most with dismal health care performance - continue to their legal challenge to the PPACA in the Courts.

Which brings us to another finding from the Commonwealth Fund, this one sadly ironic. Its last State Scorecard showed that health care is worst where Republicans poll best. Nine of the top 10 performing states voted for Barack Obama in 2008, four of the bottom five (including Arkansas, Mississippi, Oklahoma and Louisiana) and 14 of the last 20 backed John McCain. (That at least is an improvement from the 2007 data, in which all 10 cellar dwellers had voted for George W. Bush three years earlier.)

While most of the United States is waiting for the improvements to the nation's health care system that don't come into effect until 2014, in Massachusetts the future is now. In the state whose insurance mandate served as a model for national health care reform, recent polling "found that 84 percent of residents are satisfied with the Massachusetts plan." And with good reason. While 16.7% nationwide - and almost 30% in Texas - lack health insurance, in Mitt Romney's old state the figure is below 5%.

2014 can't come soon enough.

(This piece also appears at Perrspectives.)