The Massachusetts exchange is one of the most robust exchanges in the nation, with more participating carriers than other states. Moreover, the state exchange predates the Affordable Care Act by several years. The state utilizes a state-based health insurance exchange called Massachusetts Health Connector and has had its mandate since 2006. Massachusetts may see a surge in the recalibration of product design, insurance premiums, and contracting among the state's top insurers due to the Tufts Health Plan and Harvard Pilgrim Health Care merger. Aside from the merger, many health plans are moving members into alternative payment models.