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This is Day to Day from NPR News. I'm Madeleine Brand.


I'm Alex Cohen.

In Massachusetts law makers are worried that their bold attempt to cover the uninsured may fall victim to its own success. So far the state's enrolled at least 340,000 residents in free or subsidized insurance plans. That's more than double the original expectations. But the cost of providing that coverage is straining the state's budget. From member station WBUR Martha Bebinger has more.

MARTHA BEBINGER: In Massachusetts today there are hundreds if not thousands of stories like this one from Laverne Barns (ph). Barns enrolled in one of state's new subsidized insurance plans and went to the doctor. Her first visit in six years. A routine test revealed a mass in her colon that was quickly removed.

Ms. LAVERNE BARNS (Free Health Insurance Recipient, Massachusetts): Everything was found in time and it wasn't cancer. I'm very thankful that the door was open for me to get signed up with health insurance. It's a blessing.

BEBINGER: So how much does- is the co-payment?

Unidentified Man: Three dollars.

Ms. BEBINGER: Three dollars. Wow.

COHEN: Madeleine Renish (ph) says she no longer has to choose between food and medicine.

Ms. MADELEINE RENISH (Free Health Insurance Recipient, Massachusetts): I matter again. It matters that I get health care. It matters that I'm healthy. That society is supporting that a little bit.

BEBINGER: Two thirds of Massachusetts residents, who have signed up for health insurance since it became mandatory last July are getting free or subsidized coverage. The cost of that coverage is expected to more than double in one year. The cost and enrollment numbers are so fluid that state law makers aren't sure if the budget they are finalizing for July first will hold next year. And there is another looming uncertainty. A federal agreement that triggers more than a billion dollars to help cover the uninsured expires in July. And there is no guarantee that the Bush administration will maintain funding for the law.

Governor DEVAL PATRICK (Democrat, Massachusetts): The challenges we face to fully achieve and sustain its promise are almost as significant as those you faced in creating it in the first place.

BEBINGER: Governor Deval Patrick told the annual meeting of health care leaders last week that the state needs short and long term funding solutions.

Governor PATRICK: And I am asking you to join with us with the same spirit and the same commitment and the same creativity that you brought to inventing his wonderful reform to assure that it lasts.

BEBINGER: In the short term, aides to Governor Patrick are proposing additional charges on hospitals, insurance companies, and employers. The coverage law was passed with an understanding that government, individuals, and employers would all do their fair share to make it work. Greater Boston Chamber of Commerce President Paul Guzzi says that employers have done their share covering some 85,000 workers who have previous declined health insurance.

Mr. PAUL GUZZI (Greater Boston Chamber of Commerce): We feel very proud, not only of what health insurance reform has achieved, but also the role that employers have paid in looking for additional revenues from employers during this time clearly is not our first option.

BEBINGER: Guzzi says the state must make sure cost pressures don't unravel support for the law. Public support is holding even though 86,000 tax filers paid a modest penalty because they didn't have insurance last year. Ron Norton is one of them. Norton hopes to organize the uninsured when they realize that the penalty for this year is more than four times higher.

Mr. RON NORTON (Uninsured, Massachusetts): You know most people could afford to lose the 220 dollars, but I think next year, as it approaches a thousand dollars, people are going to be considerable angrier. And hopefully I can get them to mobilize.

BEBINGER: Even though the law faces uncertainties, Kaiser Family Foundation President Drew Altman says the fact that it hasn't failed yet, is a success story by itself.

Mr. DREW ALTMAN (President, Kaiser Family Foundation): Because there are a lot of people who said it won't even get off the ground, they'll be a revolt, the mandate won't work and it's still there. The implementation is moving ahead, though challenges along the way.

BEBINGER: State leaders say the key challenge will be figuring out how to hold down the rising costs of caring for the uninsured, which they call health care reform part two. For NPR News I'm Martha Bebinger in Boston.

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