Excerpt: Since its inception in 2006, many of Massachusetts's health reforms have brought about positive change: the number of uninsured has fallen by half, access to needed care has increased, and private insurance has not been 'crowded out' by public insurance programs. But the Massachusetts initiative has also seen higher than anticipated costs. In a new analysis by the Urban Institute, researchers John Holahan and Linda Blumberg summarize the state's accomplishments, examine the challenges, and suggest four options for addressing long-term costs.