Senate OK's scaled-down health bill
The uninsured could pay costs or penalties
The state Senate passed a scaled-down healthcare bill yesterday that includes a controversial requirement that could force uninsured residents to purchase private health plans within two years.
The bill, which passed unanimously, is a last-ditch effort by the Senate to salvage $385 million in annual federal Medicaid funding, which is at risk unless Massachusetts can demonstrate progress toward reducing the number of people in the state who lack health insurance.
After persistent lobbying from Governor Mitt Romney, Senate leaders included the so-called individual mandate yesterday and other changes in the bill, a more modest alternative to a sweeping healthcare plan that has stalled amid a standoff between the House and Senate.
''Is it everything? No," said Senate minority leader Brian P. Lees, an East Longmeadow Republican. ''But we certainly don't want to lose the $385 million. We certainly want to start the process of . . . getting [people] health insurance."
The bill now goes to the House, where its fate is hard to predict. House Speaker Salvatore F. DiMasi, who has expressed frustration at how the Senate has handled healthcare negotiations, will hold a caucus with House Democrats tomorrow to discuss the bill, and House staff members have asked their Senate counterparts for details on how the state would pay for the Senate plan.
DiMasi's office declined to comment yesterday.
Romney said in a statement that he applauded the Senate.
''By moving unilaterally to a compromise position, the Senate has put the interest of the people above politics," said Romney, who has worked closely on healthcare with Senate President Robert E. Travaglini in recent weeks. ''The bill isn't 100 percent of what I wanted, but it moves us much closer to our mutual goal."
The Senate plan aims to cover roughly half of the state's uninsured by making available on a voluntary basis new subsidized, stripped-down private insurance plans. The poorest residents would get free coverage, and those with higher incomes would pay premiums on a sliding scale.
The goal is to satisfy a federal mandate to move the 500,000 to 600,000 uninsured into managed health plans to reduce demands on the free-care pool, which hospitals use to treat those lacking insurance.
Under the provision added to the bill yesterday, the individual mandate would kick in Jan. 1, 2008, if the state did not trim the number of uninsured by 50 percent; the mandate would also kick in by Jan. 1, 2009, if the number of uninsured had not been reduced by 75 percent.
Under the mandate, anyone who fails to buy insurance would either pay for medical costs out of pocket or face tax penalties.
But uninsured residents would only be required to purchase insurance after a new state oversight entity established by the bill, the Commonwealth Care Health Insurance Exchange Authority, deemed the available private health plans to be affordable.
Such an individual mandate, which proponents say appropriately puts a responsibility on uninsured individuals to get coverage, is a central component to the healthcare proposal Romney put forth last year. But it was not in the scaled-back bill Travaglini unveiled Monday and was inserted yesterday after Romney made clear to Senate leaders that he was worried the federal government wouldn't approve the plan unless it contained a strong incentive for people to buy insurance.
Romney's secretary of administration and finance, Thomas Trimarco, and the secretary of health and human services, Tim Murphy, were involved in crafting the new language yesterday.
The individual mandate was also included in the healthcare measure the House passed last fall, but that bill also had a provision requiring businesses to cover their workers or pay an assessment. Without that employer mandate, the House may not agree to an individual mandate. The Senate and Romney say an employer mandate would burden businesses and cost jobs.
Rabbi Jonah Pesner of Temple Israel -- who chairs the healthcare campaign for the Greater Boston Interfaith Organization, which backs the House approach -- called the Senate's proposal for an individual mandate a ''nonstarter" because the bill has no parallel requirement on employers. Pesner vowed to continue pushing a ballot initiative this fall to extend health coverage to most of the state's uninsured.
''We're prepared to go to the ballot," he said. ''That's the endgame of all of this."
Some senators had feared the scaled-back plan would kill efforts to craft a broader reform plan with the House. Travaglini assured members that negotiations would continue and that he was still committed to passing a more comprehensive bill, senators said.
''I think the sense is that, and the assurance we've been given is, this is not in place of what we were doing before, and that this is meant to meet the deadline," said Senator Pamela Resor, an Acton Democrat.
The federal government has told Massachusetts it will lose the $385 million if it doesn't make ''substantial" progress toward reducing the number of uninsured. The federal government's goal is to have people less reliant on the free-care pool.
The federal Centers for Medicare and Medicaid Services has said that the state should have a plan in place by July 1 and that it needs 120 days to review the plan. That means Massachusetts would need to pass a plan by this week, though there's disagreement about how firm a deadline that is.
''Time is truly of the essence to give us time to review the plan and the state time to implement it," Peter Ashkenaz, spokesman for the centers, said in e-mail yesterday.
Senator Richard T. Moore, took to the Senate floor yesterday and rebutted DiMasi's accusations that the Senate has not offered a meaningful counterproposal. Moore said it was the House plan whose numbers didn't add up.
''We have been consistently attempting to move this forward," Moore, an Uxbridge Democrat, said of the Senate.
Scott Helman can be reached at shelman@globe.com. 