By upholding the individual mandate—the heart of the Patient Protection and Affordable Care Act—and by preserving Medicaid expansion, albeit at the state’s option, the Supreme Court has allowed the Department of Health and Human Services and the states to get back to the business of implementing the Act.  To be sure, challenges remain for the Administration, but health care reform has survived an important test.  As we discuss in  this article published today by Bloomberg BNA's Health Care Policy Report, the entities with whom the states will contract to build their insurance exchanges or underwrite Medicaid managed care plans should be cautiously optimistic about the future and yet mindful to secure contractual protections against political reversals.