The other 49 states in the union are watching as a Massachusetts law that requires all state residents to obtain health insurance took effect on July 1. Under the law, residents with annual incomes below the federal poverty level are eligible for no-cost care. Residents with annual incomes up to three times the poverty level can enroll in state-subsidized plans, while those with incomes more than three times the poverty level can choose their own coverage from new, lower-cost private plans if they are not offered coverage through their employer.

According to state officials, about one-third of state residents who were uninsured a year ago, or about 130,000 people, obtained coverage by the deadline. Polls and news reports have found that many people have not signed up for coverage because they don’t really know much about the new law. Only about one-fifth of those aged 19 to 26 were aware of the law.

Residents have until Dec. 31 to obtain coverage before they face a financial penalty. Residents who do not have health insurance by that time will lose their state tax exemption, worth about $219. Those who do not obtain insurance after Dec. 31 will face a penalty of up to half the cost of insurance premiums for each month a person is uninsured. Residents initially can purchase any insurance plan they choose, but by January 2009, all residents must have prescription drug coverage.