When it comes to healthcare reform in Massachusetts, a line from the classic Grateful Dead song, Truckin, comes to mind. What a long, strange trip its been.

The saga began in April 2006 with a grandiose event at Boston's Faneuil Hall, when Massachusetts then-governor, Republican Mitt Romney, signed the state's near-universal healthcare law into effect. It was a made-for-TV event that certainly raised Romney's profile as a can-do governor.  A local headline read, A Campaign Commercial in the Making.  It was theorized that with the healthcare bill's signing, Gov. Romney had given himself a significant legislative achievement whose coattails he could perhaps ride to the White House. A piece of bipartisan legislation enacted for the greater good even some local Democrats were worried the spotlight was shining too brightly on Romney.

Well, that was then. As we all know, that universal healthcare campaign never really quite materialized for Romney, nor did it catapult him to the White House. Far from it. But it did produce many strange moments on the campaign trail when former Gov. Romney would be embracing Massachusetts plan while denouncing President Obama's Affordable Care Act. For his part, Obama would often point to Massachusetts healthcare law, which created its own state insurance exchange, as a model for the Affordable Care Act.

Massachusetts did a great job of bringing people into coverage with its healthcare law, no doubt. High healthcare cost issues continued to plague the state, but over the years leaders worked to implement measures to complement the 2006 law in an attempt to curb costs.  Massachusetts was working to tackle the healthcare issue when the Affordable Care Act wasn't even in the development process. So with that said, Massachusetts path to Affordable Care Act compliance would be smooth sailing, right?

Massachusetts local health insurance exchange, the Commonwealth Health Connector, was set up in 2006 via the state law, and was working well. However, it was set up with state-specific regulations tied to Massachusetts law. When the Affordable Care Act was passed, Massachusetts despite having a functional exchange had to conform to the specifics of the federal law like every other state.

For example, Massachusetts exchange was only for those seeking unsubsidized coverage whereas under the ACA, the exchange is open for everyone. That was just one of the many nuances Massachusetts officials had to face in updating their state-run exchange. Still, though, one would presume that of all states, Massachusetts with its successful track record and acclaim as a national model could be counted on to put forth a functioning exchange website. It should've been a can't-miss prospect.

As it turned out, Massachusetts attempt to retool its exchange in accordance with the ACA was a disaster in the readiness category. One is hard-pressed to find anything that went well. The website was marred by glitches and failures from the outset, and the state ended up having to work its way through a backlog of around 50,000 paper applications. Democratic Gov. Deval Patrick was forced to bring in outside help to stop the bleeding, in the form of Sarah Iselin, chief strategy officer at the state's top insurer, Blue Cross Blue Shield of Massachusetts.

The state decided it needed to part ways with the contractor it hired for the website, CGI Group, and has indicated it may be fall before the exchange website is functioning as it should.  Meanwhile, Jean Yang, director of the Massachusetts Health Connector, recently underwent a grilling at a special congressional oversight panel in Washington, D.C. Once viewed as a healthcare rock star, Massachusetts was lumped into an undignified group of states with failed exchanges. Some suggested the state turn to the federal government or another entity to run its exchange. Certainly not the outcome state officials envisioned when preparing for the Affordable Care Act legislation state leaders had embraced wholeheartedly.

At least things haven't been dull. After all, since 2006, Massachusetts has been heralded for its healthcare law only to be derided for its healthcare exchange failure. Mitt Romney went from being all for Romneycare to being still for Romneycare but against Obamacare, though some called it Obamneycare. Yes, a long, strange trip indeed.

Follow Ric Gross on Twitter @RicGrossDRG.

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