Just 11 states have made efforts to enforce consumer safeguards under the Affordable Care Act, leading to concerns about the implementation of major health insurance provisions such as limits on out-of-pocket costs and coverage of pre-existing conditions, according to a report from the Commonwealth Fund. Thirty-nine states haven't released regulations or passed laws on seven coverage provisions. Among the provisions are a ban on coverage waiting periods; restrictions against basing costs on health condition, age or gender; and a requirement to cover 60% or more of costs.

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