Travaglini doubts that the state can afford

Senate President Robert E. Travaglini said yesterday that Massachusetts ''can't financially sustain the cost" of the sweeping healthcare plan the House approved last week. He said the Senate will take up a more cautious proposal tomorrow that aims to cover half the state's uninsured in two years.

''The numbers I'm looking at don't add up," Travaglini said of the House plan.

House leaders fired back, pointing out that the healthcare economist who has been crunching their numbers has raised doubts about the breadth of Travaglini's plan.

In a phone interview with the Globe last night, MIT economist Jonathan Gruber said the Senate plan will cover no more than 52,000 people, far fewer than the 225,000 that Travaglini is touting.

By pushing a less ambitious approach, Travaglini is putting himself at odds with House Speaker Salvatore F. DiMasi and Governor Mitt Romney on an issue that all three men want to claim as a political trophy. The House measure and the proposal put forth by Romney both seek to provide healthcare coverage to nearly all of the roughly 500,000 Bay State residents without insurance.

Travaglini said the Senate will take up a plan that is similar to the one he proposed last spring. That bill does not include a requirement that individuals purchase coverage, a strategy that both DiMasi and Romney have endorsed, or the House's controversial payroll tax on employers.

Instead of insurance requirements on individuals or businesses, the Senate plan seeks to lower the cost of coverage by allowing insurance companies to offer policies that don't include all of the benefits currently mandated by the state. The excluded benefits might include chiropractic care, in vitro fertilization, bone marrow transplants, and dentures, according to Senate aides.

They added that the new policies, which would be offered as an alternative to existing plans, would be targeted at small businesses and individuals.

Romney and DiMasi have proposed similar strategies but with state subsidies, offered on a sliding scale, to help businesses and individuals buy the new plans. Romney would allow insurance companies to trim benefits, while DiMasi would force them to cut their costs by raising deductibles and copayments.

Travaglini would expand an existing state program that offers subsidies to small businesses so they can purchase coverage for their workers. His plan also would force companies that employ 50 or more people and don't provide healthcare coverage to reimburse the state when their employees seek treatment from the free care pool.

In addition to levying a payroll tax to persuade employers to cover their workers, the House plan would require people who can afford health insurance to buy it. Romney's plan also includes a requirement that individuals purchase insurance. DiMasi's plan would expand Medicaid coverage; Romney's would not.

The one significant change from what Travaglini proposed last spring is an expansion of Medicaid to cover children in households earning up to 300 percent of the federal poverty level, or $48,270 for a family of three. The current standard is 200 percent of the poverty level, or $32,180 for a family of three. The Senate estimates that the change would bring an additional 37,000 children into the state-federal program.

Last night, Romney spokeswoman Julie Teer said the governor ''applauds Senate President Travaglini's continued support for moving the healthcare reform agenda forward."

However, Gruber, the MIT economist helping the House with its plan, cast doubt on Travaglini's approach.

''You can't cover the majority or even half the uninsured without a mandate in your plan," said Gruber. He said that the healthcare expansion in the House plan should not cost more than $700 million and that the payroll tax revenue, money from the state's tobacco settlement fund, and savings from shrinking the free care pool for the uninsured should more than cover that amount.

Healthcare groups and the state have estimated there are between 460,000 and 532,000 uninsured people in Massachusetts. But the US Census Bureau reported two months ago that the number of uninsured residents in the Bay State grew to 748,000 last year, up by 66,000 from 2003.