Massachusetts continues to be in the vanguard of reform in the American health care system. In 2006, it enacted legislation to extend coverage to the uninsured, establishing a model many of the features of which found their way into the federal health care reform legislation enacted in March 2010. Recognizing the importance of constraining cost and enhancing quality in the context of increased access, in 2008 Massachusetts adopted wide-ranging legislation that, among other elements, sought to examine provider and insurer costs and payments in order to set the groundwork for potentially comprehensive reform of the payment system (“Chapter 305” of the Acts of 2008). The third step of this development has now occurred, in August 2010, with the enactment of Chapter 288 of the Acts of 2010 (“Chapter 288”). This legislation has been explicitly presented as an interim measure—some of its provisions have a statutorily prescribed short shelf life—to provide premium relief for small business through regulation of small group and individual policies (a combined market in Massachusetts), preparatory to more comprehensive reforms anticipated to be considered in the 2011 legislative session.