found that the law was associated with "a small but consistent increase" in ED use in the state. A 2014 study found that the reform was associated with "significant reductions in all-cause mortality and deaths from causes amenable to health care." Transition to ACA At the point of the implementation of PPACA in 2014, of those citizens acquiring insurance through pre-ACA Massachusetts Health Connector plans, approximately 100,000 Massachusetts residents who received free or highly subsidized CommonWealth Care insurance, were expected be needed to be moved to Medicaid. The number of available plans under the Affordable Care Act that will offer service beginning on January 1, 2014, rose to more than 100 from just under 100 in 2013. The open enrollment period of the insurance marketplace, during which citizens may re-enroll or purchase, lasted from 1 October 2013 to 31 March 2014, but those who did not re-enroll by December 15, were to have no insurance coverage in January 2014 (unless they were among the 100,000 moved to Medicaid). At the start of the Affordable Care act open enrollment at the end of 2013, there was a major technical failure, and the MA Health Connector Software did not work at all. To handle this problem, a special temporary Medicaid was set up, and given to over 320,000 people at no immediate cost to them, who would have under normal ACA procedures gotten either a traditional Medicaid, an ACA expanded Medicaid, or an ACA on-exchange plan. The MA Health Connector was functional starting at open enrollment for 2015, though problems were still widely reported. Outcomes following transition to ACA According to the Kaiser Family Foundation, in 2019 the state's uninsured rate was about 3%, which at the time was the lowest in the country. Though 22% still have trouble paying their medical bills, "with many complaining that high-deductible health plans come with steep out-of-pocket costs." In 2022, the following carriers offer plans through the Massachusetts Health Connector insurance marketplace: AllWays Health Partners (formerly Neighborhood Health Plan) Blue Cross Blue Shield of Massachusetts (BCBSMA) Boston Medical Center/BMC HealthNet Plan (BMCHP) Fallon Community Health Plan Harvard Pilgrim Health Care (HPHC) Health New England (HNE) Tufts (two separate entities: Tufts HMO and Tufts Health Public Plan) UnitedHealthcare Fountas v. Dormitzer A legal challenge was filed in the Superior Court of Essex County, contesting the fine imposed for a citizen's failure to get health insurance as