By David A. Fahrenthold
Washington Post Staff Writer
Thursday, April 13, 2006; A06

BOSTON, April 12 -- In a Colonial-era hall, with a fife-and-drum corps marching in with him, Gov. Mitt Romney (R) signed a bill Wednesday requiring all Massachusetts residents to purchase health insurance -- portraying the measure as a historic solution to health-care costs, even as questions emerge about whether the state can afford it.

The signing, staged with a near-presidential attention to theatrics and slogan-bearing banners, made Massachusetts the first state to treat health insurance like car insurance, mandating that everyone must have it and fining those who do not.

For that, the bill was praised by a parade of speakers, each seeking the right Revolutionary metaphor.

"You may well have fired a shot heard round the world," said Sen. Edward M. Kennedy (D-Mass.), following a theme that began with the venue, Boston's Faneuil Hall, a gathering place for American patriots.

But, even amid the pomp, the bloom on Massachusetts's first-of-its-kind policy was wearing off. Some observers have charged that the plan promises a huge array of low-cost, state-subsidized health-insurance policies for the uninsured to buy -- but provides few details about how this will be done.

Specifically, the bill leaves much of the detailed work of creating these policies, including setting premiums, co-payments and the required state subsidies, to a "Connector" agency now being created.

That has left state officials with only a rough guess as to how much the system will cost -- perhaps $600 million -- and how much government will have available to pay. The money is supposed to be drawn from funds that are now used to pay for free care for the uninsured, a total estimated by the state at $1 billion.

Alan Sager, a professor at Boston University's School of Public Health, said this week that this kind of financial estimation isn't good enough for a project with such high stakes.

"That's a reckless gamble," he said, adding that the actual cost could far exceed the state's ability to pay. "This bill could do great harm if it de-legitimizes state reform efforts the way the Clinton plan, in '93-'94, de-legitimized federal efforts."

Other observers agreed that there is uncertainty about how the measure will be paid for but saw a bright side: Massachusetts leaders have already reached bipartisan consensus, which few other states have.

"They've done the heavy political lifting," said Ken Thorpe, a professor of health policy at Emory University in Atlanta. He added, however: "It's going to be interesting to see, when the details come out, whether they can hold the support together."

That kind of concern began to emerge Wednesday, amid a ceremony that seemed to set new records for state-level stagecraft. With busts of both presidents Adams looking on, Romney, Kennedy and others walked into the hall behind the musicians of the Revolutionary-reenactor Bostonia Allarum Companie. The bill was laid open by a blue-uniformed, gold-braid-bedecked member of a local historic militia company, beside a quill pen and inkwell.

Hanging on either side of the dais were banners, written in a tattered-edge, faux-ancient font, that said "Making History in Healthcare."

"I want to express appreciation to Cecil B. DeMille for organizing this event," quipped Romney, who is considering a run for president in 2008, and seems likely to use his work on the bipartisan health-care bill as a talking point on the campaign trail.

But, after praising the bill, Romney said he would try to change it, by vetoing a requirement that employers who do not provide health insurance pay $295 per year per employee.

That piqued a response from state House Speaker Salvatore F. DiMasi (D).

"To change anything [is] to disturb the delicate balance that made this law possible," DiMasi said. He said after the ceremony was over that the legislature was likely to override the veto, and that he believed it was a political gesture made by Romney with a presidential run in mind: "He's looking to the horizon now."

The ceremony closed with Romney sitting down at a wooden, old-style desk and signing the bill with 14 souvenir pens -- though he left the quill pen, evidently just a prop, in its well.

"It's law, congratulations," Romney said, and the fife-and-drum corps struck up again.

The congratulations might apply most to Romney himself. He has announced he is not seeking reelection this fall, and by July 1, 2007, when the health-insurance requirement will go into effect and the new low-cost policies must be ready, he will no longer be governor.

For some in Massachusetts, the situation has parallels to 1988, when another governor -- Michael Dukakis (D) -- proclaimed that the state had solved the health-insurance problem. In that case, the plan called for a mandate on employers to provide health insurance, and victory was declared before the final financial details were worked out.

"How sweet it is," Dukakis said then at his own elaborate signing ceremony, that one featuring a gospel group. But the law was never implemented and eventually was repealed.

As Romney prepared to leave the hall, a reporter asked him if it wasn't true that he would be gone when his own health-care bill is determined to be a "success or a sham."

"It will certainly be a big step forward," Romney said first, but then he cautioned that a lot more work is needed.

"Wish I could be here to do that," he said.