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Pennsylvania's first hearing on whether to require everyone to have health insurance hinted at the potential for a fight ahead.

The debate will involve financially powerful players such as insurers, health care providers and businesses, whose interests often are at odds. The issue surfaced after Massachusetts passed a law earlier this year requiring residents to have insurance.

The National Federation of Independent Businesses also offered an unenthusiastic view of the Massachusetts plan.

Such a plan could add $150 million to the cost of doing business for Pennsylvania companies and worsen an already bad business climate, said Mark Richards, assistant state director for the federation.