The Massachusetts House of Representatives has approved an ambitious health care initiative designed to extend insurance coverage to nearly all the roughly half-million Massachusetts residents who now lack it.
The next step is for the Senate to vote on its own version of the legislation and then for the real dealmaking to begin as a six-member conference committee hammers out a compromise version to send to Gov. Mitt Romney.
With major differences between the House plan and the one proposed by Senate leaders, that could be tough, although leaders in both chambers said they were confident a compromise could be reached this fall.
The House bill requires individuals to buy insurance if they can afford it, expands the number of people covered by the state’s Medicaid program, and attempts to close racial and ethnic gaps in coverage.
“What we are proposing today is a bold proposal. It takes bold and courageous leadership,” House Speaker Salvatore DiMasi said. “It’s a moral social obligation.”
The bill pays for the new health care program in part by tapping the state’s entire tobacco settlement fund of about $255 million a year.
Among the more controversial elements of the bill is a requirement that businesses that don’t provide health coverage to their workers pay into a new insurance fund. DiMasi said businesses that already provide insurance would be exempt.
Nearly two dozen business leaders circulated a letter to House members saying the measure would hurt the state’s still-fragile economy and make Massachusetts the only state other than Hawaii to force businesses to pay into an insurance fund.
The bill also includes penalties for individuals who fail to obtain health coverage, including blocking them from renewing their driver’s licenses.
DiMasi said he didn’t understand why businesses that already offer health insurance would come to the defense of those that don’t.
DiMasi sponsored a change to the bill in response to concerns that some businesses already providing insurance would be required to pay into the new fund. That cut the bill’s estimated revenues from $650 million to about $350 million a year, requiring use of the tobacco funds.
During the debate, Republican lawmakers offered an amendment to strip the employer mandate from the bill.
“We don’t add a huge new tax to an economy that’s already struggling,” said House Republican leader Brad Jones, R-North Reading.
DiMasi said everyone has to do their part to make the new plan work including individual citizens, the state and businesses.
“Too many times special interests of one group have denied our ability to take care of health care in Massachusetts. Don’t let that happen now,” he said.
The House rejected the Republican amendment by a 125-24 vote, enough to override a potential veto.
Romney opposes the employer mandate but shied away from threatening a veto.
“I don’t want at this point to be issuing ultimatums. I think people know where I stand on taxes however,” Romney said.
Romney urged lawmakers to move quickly. He said the state could tap into as much as $385 million in federal funds if a plan is signed into law before mid-January.
The Senate plan doesn’t require businesses that don’t insure workers to pay into an insurance fund, but does require they pay the health care costs of individual workers who receive health coverage through a state fund for the uninsured.
Senate President Robert Travaglini, D-Boston, said he was sure a compromise will be reached.
“I’m confident that the chemistry between the branches is still at a pitch and we are going to get things done,” Travaglini said. “We are going to get it right and we’re not going to be driven by any definitive timeline.”