In the United States, some, but far from all, employers offer certain forms of wage replacement when workers take a leave for medical or family reasons. In 2015, only 12% of all workers had access to paid family leave from their employers, 38% had access to short-term disability leave, and 65% had paid sick leave. Extending paid family and medical leave to all employees through a statewide program would share the costs and expand access, level the employment playing field, and reduce inequality among workers. One often-cited obstacle to providing paid family and medical leave in the United States is the anticipated cost. This report addresses that concern by examining the impacts of a statewide paid family leave insurance program in Massachusetts specified in a bill under consideration in the Massachusetts Legislature using a simulation model that provides estimates of the annual number and lengths of leaves, coverage across employees, and the costs associated with leave-taking.