BOSTON (AP) — A wide-ranging proposal unveiled by Massachusetts Senate leaders Tuesday to revamp the state's health care system establishes the now-familiar goals of lowering costs and providing residents with access to first-rate care regardless of where they live and how much they earn.

The more than 100-page bill was filed amid continued uncertainty in Washington over the future of federal health care policy, including the fate of billions of dollars in Medicaid reimbursements and subsidies for people who buy insurance through state exchanges such as the Massachusetts Health Connector.

The legislation aims to squeeze out between $475 million and $525 million in overall health care savings by 2020, leading to "slower premium increases and other consumer savings," said Senate Ways and Means Committee chairwoman Karen Spilka, an Ashland Democrat.

The measure, likely to undergo changes as it makes its way through the legislative process, represents the latest large-scale effort at health reform by state lawmakers.

In 2006, then-Republican Gov. Mitt Romney signed a bill that expanded health insurance coverage in Massachusetts and later served as a model for the federal Affordable Care Act. A sweeping measure that passed the Legislature in 2012 set annual benchmarks for containing the growth in health care costs, but produced mixed results.

Among the dozens of provisions in the newest bill are ones that seek to curb price increases for prescription drugs, reduce the number of unnecessary visits to hospital emergency rooms and smooth out vast disparities between payments made to smaller community hospitals and their large Boston counterparts.

"It's about time we get paid for our service and quality and not paid based on our zip code," said Spiros Hatiras, president and CEO of Holyoke Medical Center and one of several community hospital executives who praised the Senate proposal.

The bill also would create a new class of professionals called dental therapists who could perform certain common procedures, such as fillings and tooth extractions, in community settings such as schools and nursing homes. The Massachusetts Dental Society has offered support for the idea of dental therapists, but only if they work under the direct supervision of dentists.

Spilka said the legislation also includes some, but not all of the measures Republican Gov. Charlie Baker offered earlier this year to lower Medicaid expenses, which consumes about 40 percent of the state's entire annual budget.

Not included by Senate leaders was Baker's proposal to shift some Medicaid recipients to subsidized private health insurance plans. Critics said that could result in low-income people facing higher co-payments and other out-of-pocket costs.