The journey of national health reform legislation from concept to President Barack Obama's desk was long and winding, but not without important guideposts. Core elements of Massachusetts' 2006 health reform--near-universal, affordable coverage; changes in the small-group and individual insurance markets; and an individual mandate to obtain insurance--provided a road map for policy makers charting national health reform. Our experience with the Massachusetts reform informed our work on the Senate Health, Education, Labor, and Pensions Committee in 2008 and 2009. We compare national and Massachusetts health reforms and analyze their implications for the future.