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STEVE INSKEEP, host:

It's MORNING EDITION from NPR News. Good morning, I'm Steve Inskeep.

RENEE MONTAGNE, host:

And I'm Renee Montagne.

Health care reform may once again be a hot topic. But on the national level, it's still all talk. At state level, things are happening. In this third report at our weekly series on reforming health care, we go to Massachusetts.

If health care reform succeeds there, it could be a national model. All citizens are being told they must buy health insurance. If they do, everybody will get the care they need and the cost will be shared.

NPR's Richard Knox went to one Massachusetts town and asked people how they feel about the new law.

(Soundbite of door knocking)

RICHARD KNOX: The Tunnel City Coffee Shop sits in the middle of picture book Williamstown, nestled up against the Vermont border. Paul Lovegreen owns the coffee shop. He's very particular. The coffee is roasted on the premises. The cookies and cakes are baked here. And Lovegreen insists on just the right consistency of foam on each cup of cappuccino.

That is a fine froth.

Mr. PAUL LOVEGREEN (Owner, Tunnel City Coffee Shop): Oh thanks. Yeah, it looks like a meringue.

KNOX: That's what you want.

Mr. LOVEGREEN: Nice and thick, yes. If you hear a lot of noise when someone is making a cappuccino, they're not doing it the right way.

KNOX: Lovegreen makes his living cup by cup. He doesn't have a lot of margin for additional costs. Even so, the state is telling owners like him, who employ more than 10 full-time workers, that they have to offer health insurance.

Are you for it or against the health reform?

Mr. LOVEGREEN: Oh, I'm for it. Any ways that, you know, folks can get health insurance is a positive thing.

KNOX: I mean, is this fundamentally for you a philosophical question or is it a business question?

Mr. LOVEGREEN: I think it's a little bit of both, but I think it's more of a business question.

KNOX: That's because if employers don't start offering coverage, they'll have to pay the state a penalty for each employee.

Mr. LOVEGREEN: As a small business owner, if I was going to get a penalty of $300 per employee every year, I wouldn't be able to absorb the pit could be the potential. I couldn't do it.

KNOX: And then what's the philosophical aspect for you?

Mr. LOVEGREEN: I really think people need to be insured.

KNOX: Not all business owners are so positive; some have threatened to move to New Hampshire. But most of the onus falls on individuals. So the new law hasn't caused business owners to rebel, so far. The law requires every citizen to buy some coverage beginning July 1st. Those who don't will face an income tax penalty.

That's not the end of it. By January 2009, Massachusetts wants everybody to have meaningful insurance, with preventive care, necessary prescriptions, protection against catastrophic bills. After my cappuccino, I went across town to talk to Scott Beverly. He's co-owner of Flamingo Motors - a three-man repair shop.

(Soundbite of engine)

KNOX: What are you doing?

Mr. SCOTT BEVERLY (Co-owner, Flamingo Motors): I'm doing a brake job, so to do that you got to rip apart the whole front end here just to get the brake rotor off.

(Soundbite of engine)

KNOX: The owner of this Land Rover will pay Flamingo Motors 600 bucks for this brake job. But that doesn't mean Scott Beverly can afford regular medical care.

Mr. BEVERLY: We often compare this business to the medical, you know, my co-owner Kevin. If you sat down and figure out what the doctors or any of the health care providers are charging you per hour, it would really, you know, kind of freak you out, compared to what a normal automotive garage gets an hour.

(Soundbite of engine)

Mr. BEVERLY: Doctors, it's, you know, $75 for a 15-minute consultation.

KNOX: How about the mechanics?

Mr. BEVERLY: $60 an hour, an hour. So it's a big difference.

KNOX: Beverly is 35. He hasn't had health insurance for years.

Mr. BEVERLY: I haven't really gone for any check ups or anything because I can't afford it. So if anything major pops up, you know, even a small one, I just go to the emergency room and then just pay for it from our pocket. Unfortunately, I got a good example. Six months ago, I got a piece of metal behind my safety glasses and I had to go and get that removed.

That was 950-some-odd dollars, just to get a little sliver of metal out of my eye, which everything turned out fine. But, I mean, it was still, you know, I paid it off with what I could monthly.

KNOX: Beverly has mixed feelings about the new Massachusetts law.

Mr. BEVERLY: I think it's a good idea, but I don't think it's going to be really affordable for a lot of people.

KNOX: Massachusetts subsidizes coverage for low-income people. But Beverly makes about $45,000 a year. He won't qualify. And he's not happy the state is telling him he has to buy it on his own.

Mr. BEVERLY: I don't believe that's right. I don't think they should be able to force you to do that. It should be your choice if you want health insurance or not. I don't think anybody should be penalized as far as health insurance goes, I guess.

KNOX: Officials are worried about people like Beverly. They say the worst thing that could happen is a citizen revolt. Massachusetts may end up exempting some people from the requirement, but they can't go too far. Insurance works on the idea that everybody participates, healthy or sick. If too many people aren't paying premiums, the cost goes up for those who do.

So the state knows it can't require people to buy something if they don't consider it affordable. Scott Beverly is thinking about whether he can afford the $150 to $250 a month to buy one of the new insurance plans.

Richard Knox, NPR News, Boston.

MONTAGNE: You can read about the Massachusetts plan in detail and why one health economist from MIT thinks it will make health insurance more affordable at npr.org.

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