Massachusetts pioneered universal health care in 2006. Under then-Governor Mitt Romney, it was the first state to guarantee access to insurance — and drove its uninsured rate down to just 4 percent.

Which makes it baffling that Massachusetts did arguably the worst of any state in implementing Obamacare. Like a handful of ardent Obamacare supporters in other states, Massachusetts officials tried to pull off an ambitious launch — and failed badly.

"It was a management failure," says Don Berwick, who previously oversaw health law implementation for the Obama administration and is currently a candidate for Massachusetts governor. "Like the federal system, the state should have thrown the best IT support into it."

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