In 2006, Massachusetts passed a landmark health care law known as Chapter 58. Two decades later, this bipartisan effort has transformed how residents access and pay for medical care. The state now boasts the highest rate of health insurance coverage in the country, with nearly 98 percent of residents insured.

This massive increase in coverage has directly improved public health. Massachusetts currently ranks first in the nation for preventing premature deaths from treatable causes. The state also maintains the lowest infant mortality rates and the highest childhood vaccination rates.

To make this possible, Massachusetts prioritized affordability. Programs like ConnectorCare offer state-funded subsidies that lower the cost of premiums and out-of-pocket expenses for individuals and families. Because of these strong support systems, residents face significantly lower rates of medical debt than the rest of the United States.

The success of Chapter 58 eventually served as the blueprint for the national Affordable Care Act. Today, Massachusetts continues to adapt its policies to protect vulnerable populations and ensure health care remains accessible and affordable for everyone.

Published April 2026

Endnotes

  1. CHIA. (2025). The 2025 Massachusetts Health Insurance Survey. Retrieved from https://www.chiamass.gov/massachusetts-health-insurance-survey/
  2. The Commonwealth Fund. (2025). 2025 Scorecard on state health system performance. Retrieved from https://www.commonwealthfund.org/publications/scorecard/2025/jun/2025-scorecard-state-health-system-performance
  3. Wielawski, I.M. (2007). Forging consensus: The path to health reform in Massachusetts. Blue Cross Blue Shield of Massachusetts Foundation. Retrieved from https://www.bluecrossmafoundation.org/sites/g/files/csphws2101/files/2020-09/070700ForgingConsensusWielawski.pdf
  4. Hager, C. L. (2007). Massachusetts health reform: A social compact and a bold experiment. Kansas Law Review, 55(5). Retrieved from https://kuscholarworks.ku.edu/server/api/core/bitstreams/3c95c6f2-db2b-4d03-ad95-c97bf655ddf3/content
  5. Massachusetts Health Connector. 956 CMR 11.00 Employer Fair Share Contribution. Retrieved from  https://www.mahealthconnector.org/wp-content/uploads/rules-and-regulations/956CMR11.00.pdf. This provision was eliminated in 2013.
  6.  Love, K.A., & Seifert, R.W. (2016). 10 years of impact: A literature review of Chapter 58 of the Acts of 2006. Blue Cross Blue Shield of Massachusetts Foundation. Retrieved from  https://www.bluecrossmafoundation.org/sites/g/files/csphws2101/files/2020-10/Impact_of_Ch58_final.pdf
  7.  Later rechartered/renamed as the Massachusetts Center for Information and Analysis (CHIA) as part of Chapter 224 of the Acts of 2012. See https://chiamass.gov/mission-and-history
  8. Chapter 58 Implementation Report No. 6. (April 12, 2007). Retrieved from https://www.mass.gov/doc/070412-chapt58-update6pdf/download
  9. Kaiser Family Foundation. (2012). Massachusetts health care reform: Six years later. Retrieved from https://www.kff.org/wp-content/uploads/2013/01/8311.pdf.
  10.  Long, S.K., Stockley, K., & Dahlen, H. (2012). Health reform in Massachusetts as of Fall 2010: Getting ready for the Affordable Care Act & addressing affordability. Urban Institute, Blue Cross Blue Shield of Massachusetts Foundation. Retrieved from https://www.urban.org/sites/default/files/publication/25041/412491-Health-Reform-in-Massachusetts-as-of-Fall–Getting-Ready-for-the-Affordable-Care-Act-amp-Addressing-Affordability.PDF The Massachusetts Health Reform Survey (MHRS) was conducted for the primary purpose of assessing the impact of Massachusetts health reform and enabled the state to assess coverage impacts pre and post reform. Ongoing estimates of health insurance coverage in Massachusetts may differ from these early reports.
  11. The Commonwealth Fund. (2008). Massachusetts health care reform—On second anniversary of passage, what progress has been made? Retrieved from https://www.commonwealthfund.org/publications/newsletter-article/massachusetts-health-care-reform-second-anniversary-passage-what
  12.  Arrieta, A. (2013). The impact of Massachusetts health care reform on unpaid medical bills. Inquiry, 50(3): 165-176. Retrieved from https://journals.sagepub.com/doi/pdf/10.1177/0046958013516580
  13. CHIA. (2025). Massachusetts Health Insurance Survey (MHIS). Retrieved from https://www.chiamass.gov/massachusetts-health-insurance-survey/. The MHIS is conducted every two years to track health care coverage, access, use, and affordability trends in Massachusetts. Due to changes in the Massachusetts Health Insurance Survey (MHIS) design in 2014, estimates for 2008-2011 are not directly comparable to later years. See the 2025 MHIS Methodology Report for more information on design changes. CHIA. (2025). Retrieved from https://www.chiamass.gov/assets/docs/r/survey/MHIS-2025/2025-MHIS-Report.pdf
  14.  26 National Center for Health Statistics. (2026). National Health Interview Survey. Retrieved from https://www.cdc.gov/nchs/nhis/early-release/health-insurance-coverage.html
  15.  Long, S.K., Stockley, K., & Nordahl, K.W. (2012). Findings from Massachusetts health reform: Lessons for other states. Inquiry, 48: 303-316. Retrieved from https://www.umassmed.edu/contentassets/6396d1f75cd34b35b2e9657d86cc6946/inquiryjrnl_49.042.pdf
  16.  Community Catalyst. (2008). Massachusetts health reform: What’s the real story? Retrieved from https://communitycatalyst.org/wp-content/uploads/2022/11/mass_health_reform_august_2008.pdf
  17.  Long, S.K., Yemane, A., & Stockley, K. (2010). Disentangling the effects of health reform in Massachusetts: How important are the special provisions for young adults. The American Economic Review: Papers & Proceedings, 100(2): 297-302. Retrieved from https://www.jstor.org/stable/27805008
  18.  Sommers, B.D., Long, S.K., & Baicker, K. (2014). Changes in Mortality after Massachusetts Health Care Reform. Ann Intern Med 160(9): 585. Retrieved from https://dash.harvard.edu/server/api/core/bitstreams/7312037d-615a-6bd4-e053-0100007fdf3b/content
  19.  McCarthy, D., How, S.K.H., Schoen, C., Cantor, J.C., & Bellof, D. (2009). Aiming higher: Results from a state scorecard on health system performance. Retrieved from   https://www.commonwealthfund.org/publications/scorecard/2009/oct/aiming-higher-results-state-scorecard-health-system-performance
  20.  McCarthy, D., Radley, D.C., & Hayes, S.L. (2015). Aiming higher: Results from a scorecard on state health system performance. The Commonwealth Fund. Retrieved from https://www.commonwealthfund.org/sites/default/files/documents/___media_files_publications_fund_report_2015_dec_2015_scorecard_v4.pdf
  21. Radley, D.C., Kolb, K., & Collins, S.R. (2025). 2025 Scorecard on state health system performance: Fragile progress, continuing disparities. Retrieved from https://www.commonwealthfund.org/publications/scorecard/2025/jun/2025-scorecard-state-health-system-performance
  22.   Cantor, J.C., Belloff, D., Schoen, C., How, S.K.H., & McCarthy, D. (2007). Aiming higher: Results from a state scorecard on health system performance. The Commonwealth Fund. Retrieved from https://collections.nlm.nih.gov/master/borndig/101317176/Aiming%20Higher%20Results%20from%20a%20State%20Scorecard%202007.pdf. Note, the term used in the 2027 report was “mortality amenable to health care.”
  23.  Radley, D.C., Kolb, K., & Collins, S.R. (2025). 2025 Scorecard on state health system performance: Fragile progress, continuing disparities. Retrieved from https://www.commonwealthfund.org/publications/scorecard/2025/jun/2025-scorecard-state-health-system-performance
  24. CHIA. (2025). Burdened by the bill: Understanding medical debt in Massachusetts. Retrieved from https://www.chiamass.gov/assets/docs/r/pubs/2025/Understanding-Medical-Debt-in-Massachusetts.pdf
  25. Fulford, S.L., & Wilson, E. (2025). Medical debt and collections in the United States. Health Affairs Scholar, 3(8). Retrieved from https://pmc.ncbi.nlm.nih.gov/article
  26. Rodman, E. (2013). Re-forming reform part 2 implementing the Affordable Care Act in Massachusetts. The Blue Cross Blue Shield Foundation of Massachusetts. Retrieved from https://heller.brandeis.edu//mass-health-policy-forum/student-forum/pdfs/2019/reforming-aca.pdf
  27. McDonough, J.E. (2018). Revisiting the land of the individual mandate. Milbank, 96(2): 219-222. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC5987807/
  28. Massachusetts Health Connector. (2024). ConnectorCare Expansion Pilot: Delivering affordable, accessible health care to more Massachusetts residents. Retrieved from https://www.mahealthconnector.org/wp-content/uploads/ConnectorCare-Pilot-Expansion-Report-082624.pdf
  29. Massachusetts Health Connector. (2026). Health Connector Enrollment Report. Retrieved from https://www.mahealthconnector.org/about/data-and-reporting/health-connector-monthly-enrollment-dashboard
  30.  Doonan, M.T. & Tull, K.R. (2010). Health care reform in Massachusetts: Implementation of coverage expansions and an individual mandate. Milbank Quarterly, 88(1): 54-80. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC2888014/
  31. Soni, A. (2022). The impact of the repeal of the federal individual insurance mandate on uninsurance. Int J Health Econ Manag, 22(4): 423-441. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC8886708/
  32.  Gasteier, A.M. (2018). With the federal individual mandate gone, states might step up: Lessons from Massachusetts. Health Affairs Forefront. Retrieved from https://www.healthaffairs.org/content/forefront/federal-individual-mandate-gone-states-might-step-up-lessons-massachusetts
  33. Chapter 58 Implementation Report, Updated No. 12. (2008). Retrieved from https://www.bing.com/ck/a?!&&p=7a3e521ea8afa5dd7a23482e73171065936981147cb084f5d60bb9ca0747076dJmltdHM9MTc3MzI3MzYwMA&ptn=3&ver=2&hsh=4&fclid=390df2c3-c3c3-62b3-08dd-e5d9c24863e6&psq=ma+health+care+quality+and+cost+council+chapter+58&u=a1aHR0cHM6Ly93d3cubWFzcy5nb3YvZG9jLzA4MDQxNC1jaGFwdGVyNThkb2MvZG93bmxvYWQ
  34.  Gosline, A., & Rodman, E. (2012). Summary of Chapter 224 of the Acts of 2012. Blue Cross Blue Shield of Massachusetts Foundation. Retrieved from https://heller.brandeis.edu/mass-health-policy-forum/student-forum/pdfs/2020/summary-of-chapter-224-of-the-acts-of-2012.pdf
  35.  Massachusetts Health Policy Commission. (2023). Ten years of cost containment in Massachusetts: A decade of advancing a more transparent, accountable, and equitable health care system. Retrieved from https://masshpc.gov/news/press-release/ten-years-cost-containment-massachusetts-decade-advancing-more-transparent
  36. Altman, S. & Shactman, D. (2011). Power, politics, and universal health care. The inside story of a century-long battle. Prometheus Books.
  37. MassHealth: Roadmap to 2014. Affordable Care Act transition plan. (2013) Retrieved from https://www.mass.gov/files/documents/2017/12/18/aca-transition-plan-6-4-13.docx
  38. Ortaliza, J., McGough, M., & Cox, C. (2025). The Affordable Care Act 101. Kaiser Family Foundation. Retrieved from https://www.kff.org/affordable-care-act/health-policy-101-the-affordable-care-act/?entry=table-of-contents-what-is-the-affordable-care-act
  39. Sullivan, J., Orris, A., & Lukens, G. (2024). Entering their second decade, Affordable Care Act coverage expansions have helped millions, provide the basis for further progress. Center on Budget and Policy Priorities. Retrieved from https://www.cbpp.org/research/health/entering-their-second-decade-affordable-care-act-coverage-expansions-have-helped
  40. Kaiser Family Foundation (2026). Status of state Medicaid expansion decisions. Retrieved from https://www.kff.org/medicaid/status-of-state-medicaid-expansion-decisions/
  41. Pryor, C., & Gurewich, D. (2004). Getting care but paying the price: How medical debt leaves many in Massachusetts facing tough choices. The Access Project. Retrieved from https://www.bluecrossmafoundation.org/sites/g/files/csphws2101/files/2020-09/040200GettingCareButPayingThePricePryor.pdf
  42. Hager, C. L. (2007). “Massachusetts Health Reform: A Social Compact and a Bold Experiment”. Kansas Law Review, 55(5). Retrieved from https://kuscholarworks.ku.edu/server/api/core/bitstreams/3c95c6f2-db2b-4d03-ad95-c97bf655ddf3/content
  43. Press Release: Governor Healey Takes Nation-Leading Action to Make It Easier, More Affordable for People to Get Health Care. (January 14, 2026). Retrieved from https://www.mass.gov/news/governor-healey-takes-nation-leading-action-to-make-it-easier-more-affordable-for-people-to-get-health-care
  44. Commonwealth Connector. (2008). Massachusetts health care reform 2007/2008 progress report. Retrieved from https://www.mahealthconnector.org/wp-content/uploads/progress-reports/2007_2008ProgressReport.pdf