student performance. She passed and signed those into law on March 8, 2012. Public health Washington was one of the first states to tackle rising health care and insurance costs. Gregoire proposed major health care reforms including changes in how the state purchased health care, consolidating state health care spending, and streamlining purchasing practices. As part of the reforms, Gregoire implemented a Health Care Cabinet to ensure the state was ready. She announced, “Washington is going to lead the nation in implementing health care reform.” Through the Health Insurance Partnership, Gregoire extended health care coverage to 1,100 small-business employees. She announced legislation to modernize the state's health care and pension system, while keeping health care inflation at 4-5% year. She announced “the promise of reform is a day when no one goes without health care coverage. Gregoire pushed SB 5093, Washington State’s Cover All Kids Law, in March 2007. Advancing from this action, in 2009 Gregoire and the state legislature strengthened coverage during the financial crisis by passing HB 2128, the Apple Health For Kids Act. On May 11, 2011, Gregoire signed six bills to transform Washington’s health care system. They included creation of a health care exchange to limit health care inflation to 4% over 10 years, saving citizens $26 billion in health care costs, and legislation consolidating the state’s two largest health care purchasers to make care programs more effective. On January 13, 2012, Gregoire filed an amicus brief in support of the Affordable Care Act. On March 23 she created one of the nation’s first health benefit exchanges, giving buyers information on health care plans. Affordable Care Act Concurrently, as Gregoire made reforms in the state, she led implementation of the Federal Affordable Care Act. The ACA required the formation of a health insurance exchange in each state either by the federal government or the state. With an emphasis on extending health insurance coverage to low-income residents, Gregoire signed ESSB 5445 into law on May 11, 2011, making Washington the fourth state to implement the health insurance exchange provision. Gregoire also signed ESSB 5122 and ESSB 5371 to conform state law with the ACA by extending insurance coverage to dependents under the age of 26, removing lifetime benefit maximums, and preventing insurance companies from denying coverage to people because of preexisting conditions. Environment Gregoire said she wanted to clean up Puget Sound by making it more “fishable,