WESTFIELD, Mass. — If Congress wants all Americans to get health insurance, it will have to win over people like Gary Cloutier, owner of Cloots Auto Body Shop.

The stocky 47-year-old shows up every day to a cluttered, fume-filled garage, even when there are few cars to repair. His business has plunged 40 percent in the last year, since people stopped getting their fenders fixed. Some months he doesn’t pay himself a salary, and his utility bills pile up unpaid. So the idea of buying health insurance right now seems ludicrous. “Where am I supposed to get the money from?” Cloutier asks.

His question is directed squarely at the state of Massachusetts, the first in the nation to require all its residents to have health insurance. But it also goes to the heart of what President Obama and many in Congress are working towards – universal coverage. Achieving that goal would likely require most Americans to pay some or all of the cost of obtaining policies at a time when people are losing jobs and income…..