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On top of this financial incentive, many speculate that Republican Governor Mitt Romney's hopes for the White House in 2008 may have fostered a more moderate attitude toward healthcare. Given the recent public discontent over the spending habits of the Bush administration, it should come as no surprise that some conservative lawmakers are emphasizing a commitment to social services. Beyond Romney's political motives, new leaders in the State Senate and House made commitments to cross-party collaboration. Two influential community health groups added pressure by advocating for healthcare affordability in response to staggering expenses that threatened access to care. Premiums were raised by fifty percent between 2000 and 2005.

The universal health legislation will take effect on July 1, 2007, at which point all Massachusetts state residents over age 18 must be insured. Residents will either be covered through an employer, the Commonwealth Care Health Insurance Plan (CCHIP), MassHealth, or self-insurance. Those at or below the Federal Poverty Line will not be responsible for the payment of premiums, and families of three with incomes below $48,000 will receive subsidized state coverage on a sliding scale. Four Medicaid Managed Care Organizations (MMCO) are collaborating with state officials to insure 200,000 individuals not currently covered by Medicaid.

Those ineligible for CCHIP will acquire insurance through work or independently. Employers of eleven or more will be required to offer workers a variety of plans that can be purchased using pretax income. Large employers who do not contribute to the purchase of insurance will be fined if employees utilize the free care pool more than five times in a year. Massachusetts residents who fail to acquire health insurance will lose personal tax exemptions as a penalty. Eventually, uninsured individuals will be fined half of the cost of insurance. The individual penalties were created to encourage enrollment of all Massachusetts residents in order to broaden the risk pool, lowering costs for all. The idea is that a healthy and inexpensive majority will balance out the most ill and expensive patients.

Currently, there is little more than a legislative framework, and many are concerned that the plan may not be affordable. The outlook remains uncertain, and only one government agency is preparing for the implementation of the plan. The Connector Authority agency is responsible for integrating all parts of the legislation and will eventually serve all state residents. As the Connector Board scrambles to flesh out affordable benefit packages, a premium subsidy system, and outreach strategies by the New Year, many doubt that it will meet expectations.