It's hard to believe it's been five years since the Patient Protection and Affordable Care Act was signed into law.  Now that much of the legislation challenging the law is out of the way and most of the provisions of the law have gone into effect, we can give states a grade on how they've implemented the ACA.

"New York is one of the success stories. They have an active and effective exchange. They've enrolled millions of people, newly enrolled in private insurance coverage through the exchange and lots of people under the Medicaid expansion as well. From the coverage standpoint, New York is a relative success story," said Dr. David Blumenthal, the Commonwealth Fund president.

Blumenthal is the president of the Commonwealth Fund, a private foundation that aims to promote a high performing health care system by supporting independent research on health care issues and making grants to improve health care practice and policy.

He says New York is one of the best states when it comes to implementing the ACA.

In fact, According to the commonwealth Fund, 84 percent of New Yorkers ages 1964 now have health insurance -- that number puts them in 13th place for the highest percentage.

"If you're standard of judgment of the Affordable Care Act and its success is if whether people who didn't have insurance before now have coverage and can get access to care, by that standard, New York is doing well," said Blumenthal.

But there are still challenges. In the past year, 15 percent of New York adults went without needed care because of cost.

"New York has a very complicated delivery system. It's a high cost state. So I think the challenges in New York come from the affordability in care over the long term. They have to and they are working hard at finding ways to deliver care more efficiently. They have a very large and strong hospital sector in New York. Hospitals are not the most efficient places to take care of things that can be taken care of elsewhere. So they are working, for example, in Medicaid, to completely restructure the Medicaid Program to try to make it more efficient," said Blumenthal.

So New York's overall grade: Well, it depends on who you ask, but the American College of Physicians gives New York a "B."