The landmark health care reform that made Massachusetts the most insured state in the country and served as the framework for Obamacare turned 20 on Sunday, April 12.
As federal health care cuts that are projected to cause scores to lose insurance coverage are poised to take effect, the anniversary serves as a bittersweet acknowledgement of both groundbreaking health coverage expansion and a federal law that is eroding that care, current and former state leaders and health care advocates said.
Romneycare, also known as Chapter 58, created the first state health insurance marketplace, required adults to carry health insurance, and required larger employers to offer health insurance policies. Around 400,000 previously uninsured Massachusetts residents got coverage because of the reforms. The state’s insured rate is now 98 percent. In 2006, 6.4 percent of residents lacked health insurance, according to a Blue Cross Blue Shield of Massachusetts Foundation report.
State leaders are marking the moment with fanfare, including an event Monday at Faneuil Hall, where Romneycare was signed into law two decades prior, with expected appearances by Governor Maura Healey and former Governors Mitt Romney and Deval Patrick.
“Health care reform 20 years ago was neither perfect nor unanimous. But it has helped millions of people — first in the Commonwealth and eventually across the country — lead healthier lives,” Patrick, who served as governor from 2007 to 2015, said in a statement. “I am proud of the role my team and I played in standing up and making it better.”
Romneycare’s birthday coincides with a slew of federal health care cuts, including limits to federal health insurance subsidies and new restrictions on who qualifies for financial help.
Certain tax credit enhancements expired at the end of 2025, causing premiums to skyrocket for some low and middle-income families who purchased their own insurance through the health care exchange. About 22,000 people terminated their coverage through the Health Connector after those new premiums went into place. That’s double the number who cancelled their plans in previous years, said Health Connector Executive Director Audrey Morse Gasteier.
Additionally, President Trump’s One Big Beautiful Bill Act that passed in July took away health insurance subsidies for lawfully present immigrants. About 30,000 people in Massachusetts lost coverage because of the policy, Gasteier said.
“Being reminded that Massachusetts can do hard things and that people can do hard things is really needed,” Gasteier said. “The challenges we face are actually even greater than those we faced in 2006. It’s a steep hill ahead.”
Health care costs have also ballooned, affecting the budgets of employers, municipalities, and households. From 2023 to 2024, total health care expenditures per person in Massachusetts increased 5.7 percent. That’s the fourth year in a row the state exceeded the benchmark officials have set for the rate at which those costs should grow, which is 3.6 percent, according to analysis by the state’s Center for Health Information Analysis.
Both employers and employees are feeling the cost burden. Small and mid-size employers had premiums reach an average of $685 and $697 per member per month, respectively, according to the analysis.
During a recent hearing on state health cost trends, Retailers Association of Massachusetts president Jon Hurst said small businesses are suffering under the individual health insurance mandate, a pillar of Romneycare.
“As we have stated for many years, small employers need fairness and help on controlling health care and insurance costs,” Hurt said in written testimony.
Looking ahead to the next 20 years, health care leaders and advocates worry about a growing number of uninsured people. In addition to cost increases and subsidy reductions, more than 200,000 low-income Massachusetts residents are expected to lose coverage through MassHealth, the state’s Medicaid insurance, in the next few years because of federal changes.
Health advocacy groups like Health Care For All are ramping up efforts to limit the number of people who are kicked off the insurance for procedural reasons, said Suzanne Curry, the organization’s director of policy initiatives.
Curry said Massachusetts is still one of the best-prepared states to handle the upcoming uncertainty.
“I’m feeling really good and really happy that I’m in Massachusetts,” she said. “We have had a consistent dedication and commitment from leaders through different administrations, through different legislatures, to maintain health coverage.”
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