Source: Urban Institute

The requirement that everybody buy health insurance remains unpopular and, based on Monday's court ruling in Virginia, it may be legally vulnerable, as well. But it's worth noting that the individual mandate, as it's known, seems to be working pretty well in the one state that already has it: Massachusetts.

A new state survey conducted by the Urban Institute confirms what national surveys have already shown: Nearly everybody in Massachusetts now has health insurance. And the reason is the universal health plan that the state enacted in 2006 and implemented at the end of that year. That plan includes an individual mandate, under which residents who don't get insurance pay a fine except in very limited circumstances.

Before that law took effect, estimates suggested somewhere between 6 and 11 percent of state residents had no health insurance, depending on which survey you believed. Today the percentage of residents without coverage is less than 3 percent, according to the Urban survey. That's the lowest proportion in the country, by far. The progress among kids has been particularly remarkable. Urban's study suggests that just 0.2 percent--that's point-two percent, not two percent--of kids don't have insurance. That's as good as most universal health care systems abroad.

Oh, and all of this is despite the effects of a recession.

Of course, somebody can have health insurance but still struggle to find medical care, either because it is unavailable or unaffordable. This latest survey doesn't shed light on that question, as far as I can tell. But past surveys, also by the Urban Institute, have shown that access to care has increased--and that financial barriers to getting care has fallen.

None of which is to say the situation in Massachusetts is perfect, or even close to it. Many people, though fewer than before, still struggle to pay for their medical care. Finding primary care doctors--family doctors, general practitioners, pediatricians, and the like--can be difficult for people who don't have relationships with such providers already. And the state has not yet found a way to control the rising cost of medical care overall.

But those problems existed long before the Massachusetts law took effect. And it appears that progress on costs be in the future, thanks to the political environment state reforms have created and, eventually, to the effects of the Affordable Care Act--that is, assuming neither the Republicans nor their appointees in the federal judiciary manage to repeal it.

(H/t Austin Frakt. You're reading his blog already, right? If not, you should.)