Massachusetts has fined more than a thousand companies over $18 million for failing to offer medical insurance to their workers _ a precursor of what some business owners fear could happen on a national scale if President Obama signs a sweeping health care overhaul.

The fines are for violating a provision in Massachusetts' landmark 2006 health care law that requires larger companies to offer insurance or pay an annual fine of $295 per full-time employee.

In 2008, 807 of 23,128 eligible Massachusetts firms were found liable for the fine, known under the law as the "fare share contribution." They were on the hook for a total of $8.6 million, or an average of $10,663 per employer. In 2007, 1,045 firms were found liable for $10.5 million, or an average of $10,047 each. Statistics for 2009 were not yet available.

The Massachusetts law has been used as a blueprint for a national health care bill heading to a critical vote in the U.S. House on Sunday, and it could foreshadow how national health care reform plays out across the country.

Like the Massachusetts law, the federal legislation includes penalties for businesses that don't comply. While the federal bill would not require coverage as Massachusetts does, it hits employers with a $2,000-per-employee fee if the government subsidizes their workers' coverage.

The House bill would exempt companies with fewer than 50 employees, compared to the tighter threshold of companies with 11 or fewer workers under the Massachusetts law. The bill would also offer tax credits to help small employers provide coverage.

In Massachusetts, the law saw an uptick in the number of employers offering insurance, from 70 percent in 2005, the year before the law was passed, to 76 percent in 2009, according to the state's Division of Health Care Finance and Policy.

Overall, the state has added more than 400,000 people to the ranks of the insured since the law took effect, bringing the total number of insured residents to more than 97 percent.

That increase bucked a national trend.

In 2001, 69 percent of Massachusetts companies offered coverage, compared to 68 percent of companies nationally. By 2007, the percentage of companies offering insurance nationally had slipped to 60, compared to Massachusetts' 72 percent.

Massachusetts business groups have been split on the merits of the state's health care law.

Rick Lord, president of the Associated Industries of Massachusetts, said that since 2006, more than 100,000 workers have signed up for insurance through their employers to comply with law's "individual mandate" requiring nearly everyone have insurance or face tax penalties.

"I haven't been hearing complaints (from companies), just an acknowledgment that the percentage of their workers taking insurance is increasing," said Lord, who also sits on the Commonwealth Health Insurance connector Authority Board, which oversees the health care law.

Other business leaders in Massachusetts are chafing under the added state regulations of the 2006 law.

Bill Vernon, state director for the National Federation of Independent Business, said the pressure to offer insurance is a "job inhibitor" at a time when the state has seen its unemployment numbers climb.

"It makes it very difficult to create a job in this state. It makes it very difficult to retain the employees you have now given the cost of insurance," he said.