Individual healthcare is backed by DiMasi

Tens of thousands of people without health insurance -- many of them young, healthy, and able to afford coverage -- would be required to get insurance, just as they must now carry auto insurance, under a healthcare bill being written by House lawmakers.

House Speaker Salvatore F. DiMasi told the Globe yesterday that he backs a healthcare insurance requirement, a stance that aligns him with Governor Mitt Romney and significantly boosts the idea's prospects on Beacon Hill. The third major player in the healthcare debate, Senate President Robert E. Travaglini, has said he is open to the idea but has not committed to it.

If Massachusetts forces its citizens to purchase health insurance, it would be a national pioneer: No other state has such a requirement. A study released recently by the Urban Institute argues that it would be impossible to cover the Bay State's uninsured without requiring individuals to buy coverage.

Lawmakers are still settling the details, such as how much income a person would have to earn to face the insurance requirement and how the government would enforce it. DiMasi said he would like to protect lower-income people from the requirement. The House is also weighing a major expansion of Medicaid to cover more low income people.

In an interview with the Globe yesterday, DiMasi said the House plan ''will make people take personal responsibility when they are able to purchase health insurance for themselves and their families."

The Romney administration estimates that about 200,000 of the state's roughly 500,000 uninsured make enough money to afford private insurance with some state help. Romney has said that many of them are young, male, single, and simply gamble that they won't get sick. If they do, they go to hospitals and receive care they never pay for, because the hospital and the state pick up the tab.

Romney, who has been much more detailed than DiMasi in describing his health plan, would apply the individual insurance requirement to everyone. He wants to combine the requirement with rule changes that would allow insurance companies to offer limited, low-cost policies, and wants to provide state subsidies to help low-income people buy the policies. Under his plan, residents who choose not to obtain health insurance would face tax penalties and even the garnishment of their wages.

''I don't see how it works without an individual mandate," Romney said yesterday.

DiMasi suggested the House will follow a similar approach when it comes to low-cost coverage and subsidies. But he said he is worried about instituting penalties that are too harsh.

''The mandates and enforcement can't put people into financial hardship when they are sick or in need of medical care," he said.

DiMasi said he is ''90 to 95 percent" sure that the plan the House members of the Joint Committee on Health Care Financing will produce at the end of the month will include the individual requirement. He said he is personally committed to the idea, and his opinion will carry a lot of weight when the full House debates the plan.

John McDonough of Health Care for All, an advocacy group pushing for universal healthcare coverage, said he was troubled by the idea of requiring people to buy coverage. Health Care for All is part of a large coalition of advocacy groups and religious congregations that is collecting signatures to put a measure on the 2006 state ballot that would cover everyone by raising the cigarette tax and requiring employers to cover their workers.

''You've got families in Greater Boston that are paying over their income for rent," McDonough said. ''Is there going to be any consideration of those folks, of people who are in a situation where an affordability formula is out the window because of their individual circumstances? What are the penalties being talked about?"

But Charles Baker, chief executive of Harvard Pilgrim, said, ''The health plans and many of the folks in the business community have considered an individual mandate to be a much better way to go than an employer mandate.

''If the House is considering an individual mandate similar to the proposal made by the governor, I think there would be a fair amount of support for that in the employer and health plan community," Baker said.

DiMasi, a Democrat, is also allying himself with conservatives such as former US House speaker Newt Gingrich and Governor Arnold Schwarzenegger of California. Both have called for what is called an individual mandate by health policy analysts

Last week, the Globe reported that House leaders are also considering raising taxes on cigarettes, alcohol, or both, so Massachusetts can add 147,000 children and parents to the state's Medicaid rolls and offer state subsidies to another 200,000 more people so they can pay for private health insurance. The House, unlike Romney, has not yet detailed the extent of coverage it would require.

Raising taxes would put the House at odds with Romney and Travaglini, neither of whom backs a tax increase.

To add more people to Medicaid, the House plan would loosen the income restrictions so that children in households earning 300 percent of the federal poverty level, which translates into $48,270 for a family of three, would be eligible. The current standard is 200 percent of the poverty level, or $32,180 for a family of three.

In addition to covering more children, the House would expand the number of low-income parents eligible for Medicaid. Parents making 200 percent of the federal poverty level, $32,180 in a family of three, would be eligible under the House plan. Currently, only parents making up to 133 percent of the poverty standard are eligible.

Healthcare groups and the state have estimated that 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.

Scott Greenberger can be reached at greenberger@globe.com.