HSN11 demand is expected to exceed HSN11 funding, hospital providers experienced a $38 million shortfall during the first six months of HSN11." Versus the same period two years earlier, HSN spending plus demand has increased 20% The reduced state Health Safety Net payments anticipated (but not realized) that by reducing the number of uninsured people, Commonwealth Care would reduce the amount of charity care provided by hospitals. In a subsequent story that same month, The Boston Globe reported that Commonwealth Care faced a short-term funding gap of $100 million and the need to obtain a new three-year funding commitment from the federal government of $1.5 billion. By June 2011, enrollment was projected to grow to 342,000 people at an annual expense of $1.35 billion. The original projections were for the program to ultimately cover approximately 215,000 people at a cost of $725 million. According to the DHCFP, 89,000 people bought healthcare insurance directly as of June 2009, up from 40,000 in June 2006. The number of people with group insurance in Massachusetts held steady at around 4,400,000 since passage of the health care reform law, according to the DHCFP. One outcome has been the unavailability of coverage by many insurers previously doing business in Massachusetts. A study published in The American Journal of Medicine, "Medical Bankruptcy in Massachusetts: Has Health Reform Made a Difference?", compared bankruptcy filers from 2007, before reforms were implemented, to those filing in the post-reform 2009 environment to see what role medical costs played. The study found that: 1) From 2007 to 2009, the total number of medical bankruptcies (defined as due to unpaid medical bills or to loss of income due to illness, with no distinction between those causes) in Massachusetts increased by more than one third, from 7,504 to 10,093; and 2) Illness and medical costs contributed to 59.3% of bankruptcies in 2007 and 52.9% in 2009. The researchers note that the financial crisis beginning in 2008 likely contributed to the increased number of bankruptcies, and Massachusetts' increase in medical bankruptcies over the 2007–2009 period was nevertheless below the national average rate of increase. Still, the researchers explain that health costs continued to go up over the period in question, and their overall findings are "incompatible with claims that health reform has cut medical bankruptcy filings significantly." A 2015 study found that the law had "modest effects" on costs of outpatient care for people