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If insurance enrollment is used as a benchmark, the health care reform was widely successful. It expanded MassHealth, established an exchange where individuals could shop for fully, partially or nonsubsidized insurance, depending on their income level and enacted insurance mandates on individuals and midsize and large businesses.

A program called Commonwealth Care was established for those living below 300 percent of the federal poverty level. Those who earn up to 150 percent of the federal poverty level can obtain fully subsidized coverage through the exchange, called the Health Connector, while those at higher income levels are eligible for partially subsidized coverage.

Cost curve still rising

Mr. Kingsdale downplayed the presence of cost containment in original goals for the legislation — an area where some critics say the overhaul fell short. Health care inflation has long troubled consumers and providers, rising nearly twice as fast as the Consumer Price Index over the past decade.

“I have no argument with the contention we should contain health care costs,” he said. “It just wasn’t really the legislative objective behind our health reform.”

That is disputed by Ms. Lischko, who says those involved now try to deny that bending the cost curve was an aim. She saidthe law established aHealth Care Quality and Cost Council to recommend cost-cutting strategies for the public and private sectors, but itaccomplished little and was soon defunded as budgeting became strained.

“The panel was never a priority of the administration,” Ms. Lischko said. “The focus was on getting people access. The focus wasn’t on quality and cost.”

Of all the players in the health care industry, small businesses are the ones who complain that they got the short end of the stick. They say their premiums continued to rise disproportionately - partially as a result of a merging of the individual and small-group markets. Quoted rates for small groups rose sharply last year, by as much as 35 percent or more for 15 percent to 20 percent of members in the small-group market and by at least 20 percent for more than half of the members.

Jon Hurst, president of the Retailers Association of Massachusetts, said the law was a great success for low-income consumers, but he called it a failure on costs and for small businesses who don’t have the leverage of larger companies. He said the mandate on individuals to own insurance also puts additional pressure on businesses, even though companies with fewer than 10 full-time employees don’t have to offer coverage.

“Because your employees have to get covered, you pretty much have to offer it,” he said. “It’s a reality if you want to have good, loyal employees.”

The pressure, though, meansthe percentage of Massachusettsemployers offering insurance has risen from 70 percent to 76 percent over the past five years while the national rate stands at 60 percent.

Mr. Romney was an ardent backer of the individual mandate, which requires people to obtain insurance or pay a tax penalty, but opposed the employer mandate.