Health Insurance Massachusetts Style

"The Massachusetts reform law remains the focal point for other states and the nation in trying to figure out if state-based reform is possible," said Alan Weil, head of the Maine-based National Academy for State Health Policy. "It's the biggest game in town."

One of the most radical fixtures of the law is the so-called "individual mandate" - the requirement that virtually everyone have health insurance or face tax penalties.

Anyone deemed able to afford health insurance but who refused to buy it during 2007 already faces the loss of a $219 personal tax exemption. New monthly fines that kicked in this year could total as much as $912 for individuals and $1,824 for couples by December.

How is their experiment going, not well apparently?

Michael Tanner, a senior fellow at the libertarian-leaning Cato Institute, said the law has been an unqualified failure.

Tanner was critical of the connector authority, a "super-regulatory agency" which has mandated levels of coverage. He also noted the vast majority of the newly insured are receiving subsidized care.

"They said it would get us universal coverage and reduce costs and it's done neither," Tanner said.

The biggest challenge is rising costs.

In 2006, a legislative committee estimated the law would cost about $725 million in the fiscal year starting in July. In his budget, Patrick set aside $869 million, but those overseeing the law have already acknowledged costs will rise even higher.

Lawmakers are hoping to close the gap in part with a new cigarette tax expected to generate about $154 million a year.