http://voices.washingtonpost.com/ezra-klein/2010/07/the_massachusetts_plan_is_work.html The Massachusetts plan is working -- but the American health-care system is not In recent weeks, critics of the Affordable Care Act have turned their attention to Massachusetts, where there's some evidence that the reforms signed into law by Mitt Romney in 2005 are struggling: Emergency room visits haven't dropped. Gov. Deval Patrick has been tussling with insurers over rates. There's anecdotal evidence of small employers dropping coverage (though recent studies show employer coverage expanding). Before getting into isolated statistics and anecdata, let's do an overview: Between 2006 and the fall of 2009 (which is the most recent data [pdf] we have), insurance coverage among non-elderly adults jumped from 87.5 percent to 95.2 percent. Access to preventive care went from 70.9 percent to 77.7 percent. The gap in coverage between minority and non-minority residents disappeared. Out-of-pocket costs fell. These gains have persisted amid the recession, which is something of a surprise. State insurance plans tend to unravel during recessions. Cost, however, is where things get complicated. In the non-group market -- which is where the reforms were concentrated -- premiums costs fell by 40 percent in Massachusetts even as they rose by 14 percent nationally, according to data from the insurance industry trade group AHIP. In the employer market, which did not see major reforms, costs have risen at about the national average: The increase in Massachusetts has been 21 percent, while the increase in the rest of the country has been 21 percent. The plan's popularity also remains quite high: The Urban Institute study found approval at 67 percent in fall 2009. ----- http://www.americanprogress.org/issues/2010/04/individual_mandate.html A common criticism of the mandate is that it is either administratively infeasible or will lead to public revolt. Fortunately, we can draw on Massachusettsâ experience to address this concern. Massachusetts introduced an individual mandate in 2007, requiring all residents to purchase insurance so long as insurance was deemed âaffordable.â Individuals for whom insurance is too expensive relative to income are exempt from the mandate, much like the federal legislation, which does not require individuals to spend more than 8 percent of their income on health insurance. The penalty for not complying in 2007 was very low ($219 per person), and in 2008 it rose to $912 per person. Massachusettsâ mandate has been a success by any metric: Ninety-eight percent of tax filers complied with the mandate in its first year by either attaching proof of insurance, claiming an affordability exemption, or paying the penalty. The uninsurance rate in the state fell by two-thirds within a year of the mandate. The average cost of a nongroup insurance policy, which nationally rose by 14 percent from 2006 to 2009, fell by 40 percent in Massachusetts over that same time period. The program remains highly popular, with public support at about 70 percent in recent polls. Massachusettsâ experience shows that a mandate can indeed work to serve the goals of fundamental reform.