In a thoughtful review of the Affordable Care Act in The Journal of the American Medical Association, President Obama ends with a discussion of “lessons for future policy makers.” He talks about the difficulties in instituting change in the face of “hyperpartisanship” and “special interests” and makes a plea for “pragmatism.” Given the current state of affairs in Washington, this may seem like wishful thinking. But we think all is not hopeless, and that large employers can play a powerful role in building on what the ACA and other initiatives have achieved to date and accelerate the positive transformation of the U.S. health care system.