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Three thoughts from a top leader in the state:

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    Robert C. Garrett is chief executive of the Hackensack University Health Network, whose flagship hospital — Hackensack University Medical Center, the largest in the state — is a top-ranked nonprofit teaching and research hospital.

    What three changes would you have made to the Affordable Care Act before Congress passed it in 2010?

    1 Cost transparency: I think they could have been a little bit more transparent that to pay for this expanded insurance coverage, it's going to be coming out of Medicare. I think if senior citizens knew that from the beginning, it would have been an eye opener.

    2 Malpractice reform: There really wasn't anything done to address that piece of the cost puzzle.

    3 Doctor training: Even though there's going to be all these additional people who are going to be insured, they did not pass any legislation to help train additional doctors to take care of these people. So we already have a severe physician shortage, particularly in primary care, and there was very little incentive in the ACA on creating more physicians, creating more graduate medical education slots for hospitals that train these doctors.

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