In April 2006, Gov. Mitt Romney signed landmark legislation that aimed to make Massachusetts the first state in the country with universal or near-universal health care coverage for all residents. “An Act Providing Access to Affordable, Quality, Accountable Health Care,” often known as Romneycare or by the shorthand Chapter 58 (its designation in that year’s laws), was a pathbreaking effort to address the persistent coverage gap in US health care.

It did that through three main provisions: a requirement that all adult residents obtain insurance coverage; creation of a major insurance subsidy program for working adults without employer-sponsored coverage who were not eligible for Medicaid or Medicare coverage; and establishment of an insurance exchange – the Massachusetts Health Connector – through which individual coverage plans could be purchased.

The law was not just a breakthrough for health care policy in Massachusetts; it was the model for the development of the Affordable Care Act, enacted four years later, in 2010. Here are six perspectives on the 2006 law from a range of voices, offering high praise, strong critiques, and some mixed assessment of what the law did and where our health care system stands today. One thing they all would agree with is John McDonough’s observation in his essay: “Like it or hate it, Chapter 58 mattered.”