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In Massachusetts, test for a pioneering health plan

Its new insurance mandate kicks in July 1. Some see a model for the rest of the US.

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One of the most ambitious healthcare initiatives by a US state is entering a make-or-break implementation phase – just in time to become a model of success or failure for presidential candidates.

Starting next week, on July 1, most residents of Massachusetts will be required to carry health insurance, even if their employer doesn't provide it and even if they aren't eligible for a government-subsidized plan.

Already the Massachusetts experiment offers at least two lessons: First, a major healthcare overhaul is possible, despite all the competing interest groups. Second, a big change doesn't mean a quick fix. The state has already scaled back its early hopes that all residents would be covered.

The implementation here comes as pressure mounts on politicians nationwide to restrain rising medical bills and extend health insurance to the roughly 15 percent of Americans who lack it. Polls suggest that most Americans view the current healthcare system as broken. Federal and state budgets are strained by medical inflation. Increasingly, businesses also see a crisis – one that affects their ability to compete in world markets.

For the nation, the tough choice ahead is to define the solution. Does it involve putting more responsibility with government, with individuals, with employers, or some blend of these? What's being tested in Massachusetts is a hybrid approach, but one that puts substantial obligations and choices with individuals.

The Bay State plan has skeptics and detractors on both left and right. Supporters say that fact hints at the plan's balance – and at why it might succeed.

The plan represents a compromise of ideas proposed by Republican Gov. Mitt Romney, now out of office and running for president, and Democratic lawmakers.

"It's coming right down the middle," says Jonathan Gruber, a professor at the Massachusetts Institute of Technology who helped shape the Massachusetts plan. "It's sort of an American approach to universal coverage."

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