The Patient Protection and Affordable Care Act (PPACA) is in many ways patterned after the Massachusetts 2006 reforms. These reforms provided for an expansion of public programs, income related subsidies, health insurance exchanges, and an individual mandate. This paper reviews the evidence from Massachusetts and shows that there was a substantial increase in coverage, little crowding out of employer-sponsored insurance, high levels of compliance with individual mandate, improvement to access and use of health care services, and reduced financial burdens from health reform. The paper concludes by considering issues of provider capacity and health care costs that were not directly a focus of the legislation and but now being addressed.