Leaders look to bridge gap on health bill

House Speaker Salvatore F. DiMasi told lawmakers yesterday that he would not accept the scaled-down healthcare plan passed by the Senate this week, according to representatives at the meeting. But DiMasi and Senate President Robert E. Travaglini are set to meet on the issue today, offering supporters a glimmer of hope that a deal is still possible.

DiMasi and Travaglini, according to a legislative source familiar with ongoing healthcare negotiations between the House and Senate, will try to resolve the central sticking point: a House proposal to impose an assessment on employers that don't provide health coverage to their workers.

''The plan is to look at a reasonable assessment . . . for businesses on a per-employee basis," the source said of the meeting.

Travaglini has expressed a willingness to consider some kind of per-employee assessment on such companies, as long as it is reasonable, fearing that a stiff penalty would burden Massachusetts businesses and cost jobs.

But even if the two reach agreement on that point, House and Senate leaders would still need to iron out differences in other areas, including how much money the state can spend to fund a new plan, how to raise the money to pay for it, and what exactly it would pay for.

Today's planned meeting between DiMasi and Travaglini occurs as political and financial stakes are higher than ever. Healthcare advocates are eager to see the two leaders transcend recent tensions, and Massachusetts stands to lose millions of dollars in federal money if it fails to quickly devise a way to overhaul its healthcare system.

''There's still time, and I believe it's going to get worked out and that it's coming sooner rather than later," said John McDonough, a former state lawmaker who is executive director of the advocacy group Health Care for All. He supports the House plan.

Governor Mitt Romney and the Senate filed their healthcare bills early last year. Romney set out to cover the state's 500,000 to 600,000 uninsured residents by proposing a requirement that everyone purchase insurance. The Senate bill aimed to cover about half the uninsured by working with insurers to create limited-benefit, low-cost plans. The House came out with its version in the fall, setting out to cover nearly all the uninsured through requirements on both employers and individuals. Lawmakers also want to expand Medicaid eligibility for poorer residents.

McDonough said it was apparent to him that talks had reached what he called ''the endgame."

''Some people are looking at it and seeing evidence of a process collapsing," McDonough said. ''What I see is evidence of the process coming to a climax."

On Tuesday, with negotiations between the chambers at stalemate, the Senate approved a scaled-down bill crafted to preserve $385 million in annual federal Medicaid funding, which the federal government says the state will forfeit unless it complies with a mandate to make significant progress in reducing the number of uninsured residents. Senate leaders and Romney administration officials believe that a plan needed to be approved this week to keep getting that money, but the House believes that the state has more time to act.

The Senate billed the measure passed this week as a ''placeholder" to satisfy the mandate, but DiMasi and House members have been cool to it, saying they wanted to stay focused on the more sweeping healthcare goals they set out to achieve.

DiMasi told a closed-door meeting of House Democrats yesterday that he would not agree to the Senate's scaled-back measure, which calls for stripped-down insurance plans, either free or subsidized, for those below a certain income limit. Representatives who attended the meeting with DiMasi said there was broad support for the speaker's position.

''I think it's a fair statement that he received the overwhelming support of the members of the House," said a representative who went to the meeting and spoke on condition of anonymity, because such meetings are confidential. ''We told him to stick to his guns."

According to House members at the meeting, DiMasi said he wanted instead for the House-Senate conference committee to continue to work toward an agreement on a more ambitious healthcare plan. Senate leaders said earlier this week that despite offering the scaled-down version in the short term, they hoped that the committee would continue meeting to come up with a broader bill.

State Representative Patricia A. Walrath, House chairwoman of the conference committee, expressed optimism that an agreement could be reached soon. ''I have confidence that we will have some kind of resolution between the House and Senate shortly," said Walrath, a Stow Democrat, declining further comment.

Because negotiators are at loggerheads, the talks have been elevated to the two top leaders of the Legislature. Spokeswomen for both DiMasi and Travaglini declined to comment yesterday.

Those at yesterday's meeting with House Democrats said DiMasi and the members talked about not wanting to miss what they view as a rare shot to extend health coverage to all or most of the 500,000 to 600,000 uninsured residents of the state.

Asked whether House members expressed concern to DiMasi about losing the $385 million if the state didn't pass a bill immediately, the representative said they trusted his leadership.

''We were confident in his ability [to make sure] that the opportunity would not slip away while we were trying to do something bigger," the representative said.

A diverse coalition of groups, including Health Care for All and the Greater Boston Interfaith Organization, are pushing ahead with plans for a ballot measure that aims to bring health coverage to most of the state's uninsured.

Scott Helman can be reached at shelman@globe.com.