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In Massachusetts, test for a pioneering health plan

Its new insurance mandate kicks in July 1. Some see a model for the rest of the US.

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"I now know more about that raisin bran than I do about the guy who's going to do [an operation]," says Ms. Herzlinger, the author of a new book on healthcare.

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Another criticism is that the financial penalties – imposed next year on residents who don't buy coverage – are so small that many people won't buy.

Madeline Ortiz is currently trying to find employment that includes healthcare coverage, something she doesn't have now. She received a letter in the mail about the new state requirement, but says, "I haven't even bothered with it yet. I'm not sure what my options are."

So far, Massachusetts is the first and only state to introduce an "individual mandate" to buy insurance. But the idea may be gaining credence among other states and interest groups. The Coalition to Advance Healthcare Reform, a new advocacy group formed by large employers and health insurers, includes an individual mandate among its core proposals.

The Massachusetts plan may also be setting a standard for presidential candidates. When Democrat Barack Obama recently proposed a package of healthcare reforms, the mixed response from pundits included this refrain: His plans lack any mandate to achieve universal coverage. "That was a pretty telling sign," says Mr. Gruber, a professor at the Massachusetts Institute of Technology. "He put out a plan that a year ago would have been beyond what anybody had proposed," yet was criticized for not going far enough.

That response could reflect how mind-sets have shifted since the Massachusetts law's passage in 2006. At the very least, the law has helped prod other states, from California to Pennsylvania, to consider sweeping changes. But beyond this state, national consternation about healthcare has also been deepening as costs continue to spiral and as many employers pare back on health benefits.

Some reform proposals involve coaxing employers to do more. The Massachusetts plan calls for businesses with more than 10 workers to offer insurance or pay a fee to the state. But in states such as Hawaii, such mandates have failed in court, because federal law shields employers from facing differing rules in states where they operate.

Lawrence Mohammed, who recently opened a jewelry repair shop in Boston, says the law will probably prevent him from taking on employees. He says, "[The law] is scary, but I know it has to be done."

Polls indicate that this is a common sentiment.

In a Gallup survey last fall, 7 in 10 Americans ranked the US healthcare system as either having "major problems" or in an outright crisis. A two-thirds majority said it's up to the federal government to make sure all Americans have coverage. At the same time, a slim majority said the current system of private insurance should be maintained, rather than replaced by a government-run system.

Similarly, some other national polls have found the public to be narrowly supportive of a Massachusetts-style requirement on individuals.

"Our goal is [to cover] 85 percent of the uninsured," says Gruber. That goal would mean coverage for nearly 99 percent of the state's overall population.

Nicole Hill contributed to this report.

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