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Deadline: Volunteers leave information about Massachusetts' healthcare law at a Boston residence. July 1 was the deadline to sign up for insurance.
Elise Amendola/AP

The uninsured let a deadline pass

Massachusetts required them to get health insurance by July 1, but two-thirds haven't yet complied.

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Tony Brooks needed health insurance by July 1. It's required by law.

He might even have qualified for subsidized care, but he's not sure. In the end, he didn't sign up.

"I don't know," he says. "I just gotta read more about it."

July 1 should have been another milestone in Massachusetts' journey to universal healthcare. It's a trailblazer policy that's being watched across the nation.

So it may seem discouraging that Mr. Brooks – and up to two-thirds of the state's uninsured – haven't signed up yet. If participation falters, especially among healthy adults, the predominance of residents with high medical costs could spur investors to raise premiums, and Massachusetts could see its healthcare expenses swell.

But officials and healthcare analysts aren't worried about meeting the deadline. They say the plan's success depends on whether people sign up in the coming months, or even years.

"It's a marathon, not a sprint," says Dick Powers, spokesman for the Commonwealth Health Insurance Connector Authority, a body established by the healthcare law to oversee its implementation.

Massachusetts passed the country's first law requiring adults to get health insurance in April, 2006. In the past 14 months, it has taken several steps toward covering its 372,000 uninsured residents (about 6 percent of its population):

• It expanded the state's Medicaid program last July to include 50,000 more adults and children.

• In October, it launched Commonwealth Care, a set of state-subsidized plans for low-income residents. Of the 80,000 enrolled so far, three-quarters get full subsidies.

• In May, it unveiled Commonwealth Choice, an unsubsidized program offering a menu of private insurance plans to help individuals compare and select.

Altogether, a majority of people eligible for subsidized care now have it. There is no reliable data on how many people have bought unsubsidized insurance since the law was passed. But analysts agree it's nowhere near 100 percent of those who were required to have it by Sunday.

Why aren't Massachusetts residents signing on? Many people are only vaguely aware of the law, experts say, and don't know much about it.

"They don't know what to do, even if they have a sense that they need to do something," says Mike DeChiara of Community Partners, a health-information organization in Amherst, Mass. "There are probably some people hanging back because ... with everything new, they're just waiting to figure it out."

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