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This week, Massachusetts enacted legislation to provide health insurance for virtually every citizen within the next three years. Governor Mitt Romney says he'll sign it into law and it will be the first in the nation to require people to buy health insurance if they don't get it on the job. All but the smallest companies will face financial problems if they don't cover their workers.

As NPR's Richard Knox reports, the bipartisan plan is already being talked about as a national model.

RICHARD KNOX reporting:

Sal DiMasi is speaker of the Massachusetts House. Ask him about the new health law and he harks back to 1620 when the pilgrims landed on Plymouth Rock and wrote something called the Mayflower Compact.

State Representative SAL DIMASI (Democrat, Massachusetts): It was supposed to be a community of people where lives were made for the common wealth; that's why we became a commonwealth.

KNOX: DiMasi, a Democrat, says you can see signs of that social compact in the new law.

Mr. DIMASI: Nobody in Massachusetts will ever be turned away for healthcare. And that's a principle that I think everybody in this country should stand by.

KNOX: Ask Republican Governor Mitt Romney about the landmark legislation and he sounds like the businessman he is. When he became governor three years ago, a business colleague urged him to do something about the half million or more Massachusetts residents without health insurance. Nearly nine out of ten are in working families. Romney boned up on the problem.

Governor MITT ROMNEY (Republican, Massachusetts): The key insight was this: people who don't have insurance nonetheless receive healthcare, and it's expensive.

KNOX: The bill goes to Massachusetts businesses that do provide insurance. They subsidize a fund that pays for so-called free care when uninsured people end up in hospitals.

ROMNEY: So we're spending a billion dollars giving healthcare to people who don't have insurance. And my question was, could we take that billion dollars and help the poor purchase their insurance? Let them pay what they can afford, we'd subsidize what they can't.

KNOX: Romney started the ball rolling, the Democrats picked it up and ran with it. A strange coalition got behind it, business leaders and consumer advocates, insurance executives and clergymen, hospital CEOs and poor people. It took three tortuous years, but in the end there were only two nay votes on the carefully crafted $1.3 billion legislation that promises near universal coverage. Now the hard part begins. The law says people earning under three times the federal poverty level, that's $29,000 a year for an individual, can buy a state subsidized health plan with no deductibles and rich benefits, including dental care. Does the law contain enough state subsidy to do that?

Mr. STUART H. ALTMAN (Director, Institute for Health Policy, The Heller School, Brandeis University): I think that's a fair question and I'm not sure there is.

KNOX: Stuart Altman is a health economist at Brandeis University. He's a veteran healthcare reformer. Altman says adequate subsidies for low-income workers is just one issue. There's also the question of an affordable health policy for middle-income workers. The law says individuals must buy coverage only if it's affordable. Many may only be able to afford insurance that kicks in after the first $5,000 in medical bills.

Mr. ALTMAN: People are going to say that's unaffordable to them and others are going to say, well, you know, you got to do that in order to keep the price down. I think that's going to be a big debate.

KNOX: Altman thinks the kinks can be worked out and that the experiment will accelerate a national debate on what to do about the number of uninsured Americans, 45 million and growing.

Mr. ALTMAN: I think that there's a real possibility that this could be a catalyst for a number of other states jumping in and force the politicians at the national level to take this on sooner.

KNOX: Mitt Romney will do his part. He's running for the Republican presidential nomination. Romney brushes off right-wingers in his party who attacked the plan this week as just another big government scheme from the People's Republic of Massachusetts.

Gov. MITT ROMNEY (Governor, Massachusetts): We're going to say, folks, if you can afford healthcare, then gosh, you'd better go get it; otherwise you're just passing on your expenses to someone else. That's not Republican, that's not Democratic, that's not Libertarian, that's just wrong.

KNOX: Ed Haislmaier thinks Romney's right. He's with the Heritage Foundation, a conservative Washington think tank that consulted with Romney on the plan.

Mr. EDMUND F. HAISLMAIER (Research Fellow in Health Policy Studies, Domestic Policy, The Heritage Foundation): To be able to say, look, you had a Republican, conservative Republican governor with a Democrat legislature 5 to 1 who agreed to do this, well, you know, I don't care what the name of the state is, I mean that just tells anybody in the street there must be something there if you can actually make that happen.

KNOX: After all, Haislmaier says, welfare reform didn't happen on the federal level until Wisconsin did it first. Richard Knox, NPR News, Boston.

SIMON: Gov. Mitt Romney and Health Economist Stuart Altman have more to say about the Massachusetts law on our Web site, NPR.org.

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