SACRAMENTO — Facing a September deadline to create the universal or near-universal healthcare system they've talked about all year, lawmakers and health policy experts are now confronting the issue's most politically sensitive question: How much can ordinary Californians afford to pay?

That issue — affordability — bedeviled and partially derailed the heralded universal healthcare plan in Massachusetts, upon which the California proposals are partly based. Earlier this year, Massachusetts regulators decided to exempt 20 percent of the uninsured from that state's insurance mandate after concluding not everyone could afford to pay the premiums.

Len Nichols, a veteran of healthcare debates since the Clinton administration and now director of the New America Foundation's health policy program, recently visited Sacramento to share a basic fact of life with those considering reforms.

"You cannot credibly require people to buy something they can't afford," he said...

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