State Senate OK's healthcare plan

Setting up a battle with the House, the Massachusetts Senate approved a healthcare plan yesterday designed to cover about half of the state's roughly 500,000 uninsured residents over the next two years.

The Senate plan is more cautious than proposals by the House and Governor Mitt Romney that aim to cover everybody, and yesterday's unanimous vote was a prelude to the upcoming negotiations over whether Massachusetts can afford to become the first state to insure everybody.

The Senate plan does not include a requirement that individuals purchase coverage, a strategy that House Speaker Salvatore F. DiMasi and Romney have endorsed, or the House's controversial payroll tax on employers. Both the Senate and House plans would expand MassHealth, the state's Medicaid program, while Romney's proposal would not.

The resulting compromise would be sent to Romney, who would like to have a major healthcare expansion on his resume if he runs for president.

Senators did take one step toward the more ambitious approach favored by the House yesterday, voting to extend government-funded Medicaid coverage to 16,300 low-income parents and 8,000 legal immigrants. The amendment also would restore certain Medicaid benefits the state eliminated in 2002, including payments for dental care, eyeglasses, and prosthetics. The House bill includes similar changes, though it would only restore benefits to elderly and disabled immigrants.

Earlier in the week, Senate President Robert E. Travaglini disclosed that he had altered his original healthcare proposal to expand 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 will bring an additional 37,000 children into the state-federal program. The House plan includes the same change.

Senate leaders said the Medicaid expansion will cost $105 million. The federal government will chip in $47.5 million, and senators say they will get the rest of the money by scaling back planned increases in Medicaid reimbursements to hospitals.

Senator Mark Montigny, the New Bedford Democrat who proposed yesterday's Medicaid amendment, pointed out that all three plans on Beacon Hill would allow insurance companies to offer cheaper, private health plans, but only Medicaid helps ''the mass of people who have no chance of affording even the most low-cost product."

''Although the number 25,000 sounds insignificant, if you're one of those, it's life-saving," he said.

The proposed expansion of Medicaid coverage placated some critics, who were upset that the Senate plan did not go far enough.

An hour before yesterday's debate was scheduled to begin, several dozen members of the Greater Boston Interfaith Organization rallied at the State House to denounce Travaglini's proposal as too timid. The Rev. Hurmon Hamilton, who chairs the group, urged Travaglini ''to bring real reform, not to the few, but to the masses."

''We respectfully caution you today that your bill as currently written is one that covers a small percentage of the uninsured, despite the claim of covering 50 percent," Hamilton said at the rally.

By the end of the day, senators had voted to cover an additional 24,300 people, just a fraction of the uninsured. Nevertheless, Hamilton and John McDonough of Health Care for All, another leading advocate for universal coverage, stood with Travaglini and other senators after the vote to praise the final product.

''Tonight what we have seen in this legislation is a real commitment to real healthcare reform," Hamilton said. ''There are still a number of prayers that are lingering to be answered, but this is a significant start."

Romney has refrained from criticizing the Senate's more cautious approach, but House leaders have promoted the views of their hand-picked healthcare economist, Jonathan Gruber of the Massachusetts Institute of Technology, who said Travaglini is greatly overestimating the impact of his plan.

In a meeting with reporters arranged by DiMasi's staff, Gruber said yesterday that the Senate plan would cover, at most, an additional 50,000 people. His estimate did not include the Medicaid expansion adopted on the Senate floor, however.