The Obama administration’s implementation of the 2010 healthcare law will help shape the president’s legacy, for better or worse.

Federal and state officials are preparing to launch the health law’s insurance exchanges on Oct.1. But while most attention is trained on federal Health secretary Kathleen Sebelius, there are many others behind the scenes playing important roles in setting up the health exchanges, preparing for the Medicaid expansion and trying to get the public on board.

The Affordable Care Act (ACA) has been called one of the most complex government undertakings in a generation. It will touch almost every corner of the U.S. healthcare system and define that arena for the foreseeable future.

Here are 10 key players to watch as the law is implemented.

* Debbie Curtis (Deputy Policy Director, District of Columbia Health Benefit Exchange)

Curtis is well known to many on Capitol Hill for her work on House Ways and Means Democratic staff and as chief-of-staff to former Rep. Pete Stark (D-Calif.), once the chairman of the powerful Ways and Means Health subcommittee. Curtis also lobbied for Consumer Action, a consumer advocacy group, during debate over the Clinton health plan.

As an expert on health insurance, Curtis was recruited early this year to help the District of Columbia set up its new health insurance marketplace. The exchange is notable because it’s where D.C.-based congressional aides will be required to purchase coverage. The District’s small businesses will also be required to purchase their employee health insurance through the marketplace starting in 2015 — an ongoing source of controversy in the city.

* Andy Allison (Arkansas Medicaid Director)

Allison has been called a visionary for his role in a proposal to use funding from ObamaCare’s Medicaid expansion to finance the purchase of private coverage for low-income people on the state’s insurance exchange. The plan is seen as a possible red-state alternative to the expansion and has been approved both by federal health officials and the Arkansas state legislature. It’s also expected that the plan could lower premiums on the exchange and draw in new insurance carriers.

Allison moved the Arkansas Medicaid program away from fee-for-service payments and toward a model that rewards quality and efficiency. He formerly served as head of Medicaid in Kansas, and started his work in the field as a Medicaid analyst at the Office of Management and Budget.

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