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A study released in January by cSPA found that the millionaire’s surtax could raise a “meaningful amount of money” in a “highly progressive way likely to advance racial and economic equity.”

cSPA issued a report last week that predicted a mix of outcomes: Insurers may lower monthly premiums, streamline operations..., or pay more in dental claims by covering more procedures or allowing dentists to bill higher prices.

The report by Tuft’s University’s Center for State Policy Analysis suggested that while most large dental insurers would likely be able to comply with proposed requirements, smaller providers would face increased financial pressures.

Why are Massachusetts dentists and orthodontists spending hundreds of thousands of dollars on a campaign to change the rules governing dental insurance? Evan Horowitz, executive director of cSPA, has the answer in a report released Thursday: money.

According to an analysis by Tufts University’s Center for State Policy Analysis, the pool of wealthy households in Massachusetts changes dramatically year to year with only about half consistently earning incomes of more than $1 million.

It is difficult to gauge whether the loss ratio is pegged at the correct amount, as well as what impact it could have on dentists and patients, according to a cSPA report.

But it's also not plausible to say well, [millionaires tax revenue] could end up anywhere, there are really no fences on it. There are fences on it and the fences are - what is it people and the legislators want to put their money towards?"

Where the money goes "depends on a lot of different factors," Horowitz said. "How strong are the unions pushing for you to use this money in a particular way? How accountable are your politicians? How easy is it to count up the money?"

In 2019, just 0.6% of Massachusetts households boasted incomes above $1 million — yet they accounted for 22% of all taxable income, the Center for State Policy Analysis said in January.