Background: Preoperative nasal colonization with Staphylococcus aureus (SA) is a strong risk factor for surgical site infection (SSI). Methicillin-resistant SA (MRSA) positive carriers are at a much higher risk of SSI than MRSA negative patients. MRSA screening is expensive. Treatment of everyone with single dose antibiotic is very inexpensive, but has downstream negative consequences. This presents a conundrum. Surrogate measures for MRSA colonization may include insurance status in individuals below Medicare age. Massachusetts Health reform law mandates that Massachusetts residents obtain a state government-regulated minimum level of healthcare insurance coverage termed MassHealth.