Many Americans have been watching with great interest as President Barack Obama attempts to be the first president to successfully push through a wide-ranging health care bill that will significantly change the way in which private health care providers operate. The private model has been a staple of the American insurance industry for a century, and all other attempts to change it have met with defeat. Now, it appears as though the President's insurance reform may actually be successful, and many are wondering just what will happen when the law comes into full force and effect. As it turns out, however, the President was not the first to think of such an idea, as one only needs to look to Massachusetts health insurance to see, in large part, where much of the impetus for national reform has come from.

In 2006, the Massachusetts Health Care Insurance Reform Law was enacted, which meant that every resident of the state had to obtain health insurance that was regulated at least in some part by the government. This regulation mostly took the form of a minimum standard of care - a familiar theme in the President's Act - and those who did not obtain health insurance approved by the state were subject to fines, including the loss of a $219 personal exemption on their income tax. The state also provided subsidized health care for those making less than 150% of the Federal poverty level in order to allow them access to health care. The law went so far as to say that citizens could not refuse to have health care on the basis that the cost was "unreasonable," and that the state could determine what, overall, constituted reasonable in each case.

It is clear that in many respects the President has borrowed from the model, hoping that what has been successful in the state for a number of years can work for the country as a whole as well. By tackling the problem of those who are uninsured and setting up a system of fines for those who chose not to be, the Massachusetts health insurance legislation was focused on attempting to limit the amount of defaulted payments for hospital services and reduce the number of patients in debt, something that President Obama hopes can happen across the nation.

While the Massachusetts insurance reform system is not perfect and the state still faces a number of large healthcare debts, the new legislation introduced to Congress has borrowed a great deal from the state and the ways in which it has chosen to seek public remedies to private insurance issues.