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In April 2006, the Massachusetts Legislature passed Chapter 58 of the Acts of 2006, An Act Providing Access to Affordable, Quality, Accountable Health Care, sweeping health reform legislation designed to achieve nearly universal health insurance coverage.1 While Massachusetts is not the first state in recent years to enact legislation intended to achieve near-universal coverage, its efforts have attracted the most national attention and the most notice from other states interested in duplicating the Massachusetts Model.

Fortuitous political and budgetary circumstances converged in Massachusetts to move reform forward. First, stakeholders and elected officials worked together over a number of years to develop a political consensus that the goal of health care reform should be universal coverage-or at least near universal coverage-and that anything short of that goal would have undesirable human, financial, economic and political costs.2 Moreover, the Commonwealth already allocated over $1 billion a year to cover the costs of care for the uninsured, money that could be partially or fully shifted to help subsidize health insurance coverage for low income families in a system designed to create near universal coverage.3 Finally, the threatened loss of $385 million in federal Medicaid matching funds on July 1, 2006, helped propel the Commonwealth to quickly enact reform legislation quickly.4