Many individuals and small employers living in Massachusetts are still not sure how they will pay for health coverage even after the state’s “universal health care” rules take effect.

Laurie Felland and other researchers at the Center for Studying Health System Change, Washington, have published a sampling of Massachusetts’ residents’ views in a report based on interviews with 25 market observers, including representatives for health plans and employer groups as well as consumer advocates, health care providers and state agency officials.

Massachusetts is requiring many employers with 11 or more employees and many uninsured individuals to buy health coverage, and it is preparing to impose new charges on employers and individuals that fail to obtain adequate coverage.

Affected employers, for example, are supposed to pay $295 per year for each uninsured employee if they do not make “fair and reasonable” contributions for workers’ coverage.

Massachusetts is supposed to subsidize coverage for low-income and moderate-income state residents, and it is gearing up to help small employers and higher-income individuals bargain for better deals from private insurers.

The new requirements could cause burdens for owners of small firms, the researchers write.

“It’s ironic,” one study participant told the researchers. “The big employers who will not be impacted probably know the most because they have the ability and staff to keep up with the changes. Small employers just don’t have a lot of resources.”

“Places like sandwich shops and auto repair companies are not embracing the reform,” an insurance broker told the researchers.

The study participants warned the researchers that employers could start “pushing back” as coverage purchase rules begin to take effect.

Some individuals and employers may choose to pay tax penalties rather than to buy health coverage, the researchers write.

The state health reform law already permits individuals to avoid complying with the individual purchase requirements if they can show that they are unable to find affordable coverage.

In April, the state agency in charge of helping moderate-income residents find coverage “reported plans to exempt nearly 20% of uninsured adults (approximately 60,000 people) ineligible for state subsidies from the individual mandate after determining that even the lowest cost insurance is unaffordable for them,” the health system change center researchers write.

“The less affordable coverage is for consumers, the more likely the state will have to commit additional monies to subsidize people to achieve near universal coverage,” the researchers warn.