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KAI RYSSDAL: In talking about healthcare tomorrow night, the President’s taking his lead from states that decided they needed to do something if the Feds wouldn’t.

Massachusetts was the first. Last October, the Bay State started signing up its low-income uninsured for universal coverage.

Helen Palmer reports now from the Marketplace Health Desk at WGBH, some cracks in that plan are starting to show.

HELEN PALMER: Uninsured Massachusetts residents who earn more than $29,400 — that’s three times the poverty rate — would face a premium of about $380. That’s far higher than the $200 the plan’s architect, ex-Gov. Mitt Romney, originally proposed.

That premium’s not a total surprise, says MIT health economist Jonathan Gruber.

JONATHAN GRUBER: You know, we are suggesting a more comprehensive policy than the governor had originally anticipated, I think, when he said $200.

Gruber’s part of the team hammering out the details of the plan. It’ll pay for some preventive care and cap out-of-pocket expenses at $5,000 per person.

Gruber says the $380 premium was an average.

GRUBER: Many insurers did come in at much lower prices. And so I think there is room to move here and I think that we will work this out.

But other health economists call the plan fundamentally unsound. Alan Sager of Boston University’s Health Reform Program:

ALAN SAGER: The Massachusetts healthcare law does nothing to contain costs and does nothing to squeeze out the enormous waste that pervades healthcare in Massachusetts.

Yet to date, the plan’s a wild success. Since it kicked off nearly four months ago, 85,000 uninsured people have signed on.

But they were the easy ones, the very poor whose coverage is free or heavily subsidized. Getting a better deal for the rest of the uninsured will be the real test.

In Boston, I’m Helen Palmer for Marketplace.