The Patient Protection and Affordable Care Act (PPACA) is the most significant health policy legislation since Medicare in 1965. The need to address rising health care costs and the lack of health insurance coverage is widely accepted. Health care spending is approaching 17 percent of gross domestic product and yet 45 million Americans remain uninsured. But how to address these issues remains highly contentious. The Massachusetts polity confronted the lack of universal health insurance coverage four years ago. Massachusetts now requires that all adult residents purchase affordable health insurance. The state set up a health insurance exchange for the purchase of non-group coverage and established a program to subsidize insurance for lower-income families. This article presents an exchange of views regarding implications of health care reform in Massachusetts on the likely impacts of the Patient Protection and Affordable Care Act.