Massachusetts continues to move forward on comprehensive health reform. Uninsurance is at historically low levels, despite the recent economic downturn. Building on that coverage expansion, there have been improvements in access to care and the affordability of care in the commonwealth. Notwithstanding these successes, some of the early gains under health reform in reducing barriers to care and improving the affordability of care had eroded by Fall 2008, reflecting trends that predate health reform in Massachusetts-constraints on provider capacity and increasing health care costs. Because these are national concerns as well, Massachusetts continues to offer lessons for national health reform efforts.