Mass. group set to push for universal healthcare

A coalition of religious and community groups will launch a drive today to put universal healthcare on the 2006 state ballot, in a proposal that would raise the cigarette tax to buy coverage for more people and would require all but the smallest Massachusetts businesses to cover their workers.

The Greater Boston Interfaith Organization argues that its approach would go further to reduce the ranks of the state's 500,000 uninsured than the alternatives under consideration on Beacon Hill that are backed by Governor Mitt Romney and Senate President Robert E. Travaglini. The Greater Boston Interfaith Organization, which includes 65 religious congregations and community groups in Eastern Massachusetts, says its plan would cover everybody by expanding the state's insurance program for the needy and by forcing businesses to provide coverage.

Romney and Travaglini want to make private insurance more affordable by allowing insurance companies to offer lower-cost policies with scaled-back benefits. Neither of their plans includes a tax increase or an ironclad employer mandate, an approach that the business community strongly opposes.

''We think the Senate president is off to a great start, but we want to do two-thirds more than what the Senate president wants," said Rabbi Jonah Pesner of Temple Israel, one of the leaders of the effort. ''We're happy to work this out with the Legislature in the next two months. But we're prepared to go to the ballot initiative, and we're prepared to raise the thousands of signatures to get it on the ballot if necessary."

The group would have to collect approximately 40,000 certified signatures to put the proposal before the voters. Even if backers achieve victory at the ballot box, they may not get what they want: In recent years, the Legislature has ignored two measures that voters approved, scuttling a campaign finance measure and indefinitely delaying an income tax reduction.

Romney spokesman Eric Fehrnstrom said the governor is committed to expanding healthcare coverage, but rejects the strategy backed by the religious leaders.

''Both the governor and the Senate president have made it clear that tax increases and employer mandates are off the table," Fehrnstrom said.

Travaglini and his aides could not be reached for comment. While avoiding a direct employer mandate, the Senate president's plan 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 public free-care pool.

A fourth healthcare proposal is also in the mix, though it would travel a different path. Last July, lawmakers approved a proposed constitutional amendment requiring the Legislature to come up with a plan for universal healthcare coverage. Under that proposal, the Legislature would have to ''enact and implement such laws as will ensure that no Massachusetts resident lacks comprehensive, affordable" health insurance coverage.

Legislators would need to approve the measure again in a Constitutional Convention this year or in 2006, to put the proposal on the November 2006 ballot.

By contrast, the ballot initiative being proposed today by the Greater Boston Interfaith Organization does not seek to amend the state Constitution, and it is far more specific. Though they might maneuver to block it, legislators would not have to approve the measure for it to become law.

The plan hews closely to a bill authored by Senator Richard T. Moore, the Uxbridge Democrat who cochairs the Legislature's healthcare finance panel. That plan stakes out ground held by many healthcare advocates, who say that covering everybody in Massachusetts is impossible without spending more money and requiring employers to provide health coverage. But so far, Moore's proposal has gained little traction on Beacon Hill because of political opposition to new taxes or mandates on businesses.

Ari Lipman, a spokesman for the Greater Boston Interfaith Organization, said the ballot initiative would not contain all of Moore's proposals, but it almost certainly would include an expansion of MassHealth, the state coverage program for the poor; subsidies for small business and the self-employed to help them pay for coverage; and surcharges on businesses that can provide insurance to their workers but do not.

Under Moore's similar proposal, the state would add 50 cents to the $1.51 per pack cigarette tax, a move that might raise as much as $150 million a year. Much of that money would be used to expand MassHealth, the Bay State's Medicaid program.

To push businesses to provide coverage, Moore would levy what he calls a ''health access assessment" on employers who do not offer health plans to their workers. The payment would be calculated as a percentage of payroll, and firms paying total salaries of $50,000 or less would be exempt.

Moore's proposal also would provide state subsidies to small business and certain low-income individuals to help them purchase insurance. The state would automatically enroll in private plans people whose employers don't provide insurance.

Lipman said the group has already enlisted the support of many small business people who would like to provide healthcare coverage to their workers but can't afford it.

But the state's leading business groups have been united in opposition to any mandate on employers. Brian Gilmore of Associated Industries of Massachusetts said an employer mandate ''would raise the profile of Massachusetts as a difficult place to do business," and might cost the state jobs.

''Everybody's for healthcare, but the fly in the ointment is how to provide for it, pay for it, and make it affordable," Gilmore said.

In 1988, the Legislature approved a measure that levied a surcharge of $1,680 per worker on businesses that failed to provide coverage, excluding firms with fewer than six workers. But that plan, promoted by Governor Michael S. Dukakis, was scuttled by his successor, William F. Weld. Today, only Hawaii has an employer mandate.

Nevertheless, the leaders of the healthcare campaign say there is a moral and religious imperative to make sure that every citizen is covered. Eddly Benoit, a church elder at Dorchester's Temple Salem Seventh Day Adventist Church, said that up to a fourth of the members of that congregation lack health insurance.

''One of the things that we preach from the pulpit and is taught to us in the Bible is that our body is the temple of Christ, and because our body is the temple of Christ we have to treat it appropriately," Benoit said.

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