Moving to Universal Coverage: Health Care Reform in Massachusetts

State health care reform in Massachusetts has involved a phased process, focusing first on coverage expansion and then turning to delivery system innovation and cost containment. In 2006, the state adopted an individual mandate to obtain health care coverage which, along with a Medicaid expansion and creation of an exchange for two new health insurance programs, reduced the proportion of uninsured to below 3% within three years. In 2009, high and rising health care spending called into question the sustainability of these reforms. Massachusetts prepared to implement its second wave of changes, which included delivery system reforms and a proposed shift from fee-for-service to "global payments" covering all or most of an individual's care. The case examines the content and sequencing of both phases of health care reform in Massachusetts, enabling discussion of health care system-level strategy and the relationship between coverage, care delivery, and spending.