As a state legislator in Massachusetts since 1985, I have seen the best and worst of state health policy-making. In 1988 the Massachusetts Legislature approved a measure intended to guarantee health insurance to all 600,000 uninsured state residents. The early steps under the law, covering students, the unemployed, and disabled adults and children, were preludes to a requirement, effective in 1992, that all employers provide insurance or pay for coverage by the state. Although flawed, the plan represented a striking effort by one state to push ahead of the federal government in the achievement of universal health insurance.