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Various factions wrangling over national health care reform can look to local lawmakers for debating points based on their view of Massachusetts's mandatory insurance program - the first and only in the nation.

For Republican Rep. Betty Poirier of North Attleboro, the growing costs of the Massachusetts program is cause for concern.

"I don't know in its present form how sustainable it is," she said.

But Democrat Bill Bowles, who represents Attleboro, thinks the program saves the state money in the long run.

"I don't think that it's a budget buster," he said, "and the cost would get worse without it." There is no question the state program has been successful in reducing the number of uninsured. Only 3 percent of Massachusetts residents remain without insurance, compared with 15 percent nationally.

Since 2006, more than 400,000 residents have become insured. Of those, 180,000 are enrolled in Commonwealth Care, the state's subsidized insurance program.

"There is a need for simple, basic coverage," Poirier said. "That's what we passed."

The state, however, is in tough financial shape, and lawmakers are looking for ways to plug the growing budget deficit.

The rising cost of the insurance program is worrying some lawmakers.

Since 2006, state spending on health insurance has risen almost 70 percent - from $1.04 billion in its first year to a projected $1.75 billion in fiscal year 2010.

Over the same time period, health care costs have risen at four times the rate of inflation. State unemployment rates have risen to just over 9 percent - up 3 percent from a year ago - which means more residents are entitled to subsidized insurance.

In the midst of a budget crisis, the state is struggling to cover its health care commitments. Gov. Deval Patrick recently backed off an extensive coverage plan for legal immigrants.

Poirier says some of the costs could be cut by offering a range of less expensive insurance plans that allow people to pick and choose their coverage.

"We go a long way toward getting people the coverage that they need, but we may have gone a little overboard," Poirier said. "I think now we're demanding things that perhaps everybody doesn't need." Poirier points out there's no reason for post-menopausal women to have pre-natal care coverage, while coverage providing payments for prescription drugs are more important for older residents than healthy, younger people.

The Massachusetts model has been in the spotlight over the past few months as Washington debates President Barack Obama's national health coverage plan.

Congressmen and senators on both sides of the aisle are pointing to the state as an indication of what's right and wrong with mandatory health coverage.

Lawmakers here hope that Washington learns from the state's experience.

Poirier said she hopes Congress will take the time to study the Massachusetts program to "see what we've done right and what we've done wrong."

But Bowles believes that, ultimately, Massachusetts is headed in the right direction.

"On the national level, the Massachusetts plan is a good model," he said.