The Cato Institute recently released a study of health reform in Massachusetts by Aaron Yelowitz and Michael F. Cannon, entitled "The Massachusetts Health Plan: Much Pain, Little Gain." That study reports fewer gains in health insurance coverage and higher costs than have been reported by earlier studies. As the Urban Institute has done a substantial amount of research on health reform in Massachusetts, we have received a number of requests to reconcile the findings on health insurance coverage from the Cato study with the findings from earlier work. This paper is a response to those requests.