Passed in 2006 and fully implemented in January 2008, the Massachusetts Health Reform Law, or Chapter 58 of the Acts of 2006, established a nearly universal health care program for its residents. Its purpose was to increase the number of those covered by health insurance and not necessarily reduce the costs associated with treatment, which would be addressed two years later. Individuals who purchase their own coverage and those who are covered through their work at a small business with 50 or fewer employees were placed together in one pool, with the hope that this would make coverage more affordable for individuals. Adults earning 100 to 150 percent of the federal poverty level and children whose parents earn up to 300 percent are eligible for free insurance through the reforms. An individual mandate was established, under which individuals were required to purchase health insurance or face a penalty. Those to whom the punishment would be a burden could be exempted from this. There were subsidies for those with low incomes, an expansion of Medicaid, and a requirement for employers to provide coverage to employees or pay a penalty. There were various ways the state was able to fund the new health care program. One way was through taxes, such as adding $1 to every pack of cigarettes. Other sources of revenue included individual and employer fines from those without coverage. Health care reform in Massachusetts has occurred largely because the state has great flexibility in how it spends its Medicaid funds. This flexibility allowed payments to be made to hospitals that needed to be compensated for treating uninsured people. The state needed to clarify… halfway through the document… researchers should have made the distinction between the two, as it could have provided more information about how the Massachusetts law was affecting doctors' care of patients . One issue addressed in the reading, but not fully discussed, was how Chapter 58 established a requirement that the fees paid to doctors and hospitals who treat Medicaid patients be substantially increased. I wish this point had been explored more in the article because many doctors refuse to see patients on Medicaid because they are paid so little to do so. I thought this small, but also significant, aspect of healthcare reform was crucial to help expand people's coverage and choices when it comes to choosing a doctor. Without this pay increase, fewer doctors would continue to accept Medicaid patients in the future.