With the passage of national health reform legislation modeled on Massachusetts’ 2006 reform initiative, the Bay State continues to provide important lessons for the nation. Most recently, Massachusetts has shown that although it is difficult, sustaining the gains of health reform in a severe recession is possible. The state’s uninsurance rate, 4.8 percent for nonelderly adults, remained at a record low in fall 2009. Access to health care improved, and the burden of high health care costs on individuals was reduced. However, challenges remain, as some barriers to care persist and escalating health care costs continue to be an issue.