Every Massachusetts resident would be required to have health insurance on July 1, 2007, under a landmark healthcare bill the Legislature could send to Governor Mitt Romney as early as today.
The agreement, unveiled by legislative leaders yesterday, aims to increase coverage in phases over three years to include 90 to 95 percent of the uninsured, through the insurance requirement for individuals, along with a new assessment on employers that don't cover workers and creation of private, subsidized health plans for people who can't afford them on their own.
The 145-page bill is the result of more than four months of occasionally bitter negotiations. It melds ideas from the House, the Senate, and Romney, who put forth competing healthcare plans last year that have often seemed irreconcilable. The bill appears headed for law, given that Romney yesterday called it ''exactly what we'd hoped for."
Romney has been adamantly opposed to a new payroll tax on businesses. But though he stopped short of saying he would sign that facet of the bill yesterday, the governor said he had no major objections to a proposed $295-per-employee charge on employers who don't provide insurance, a component designed to raise about $45 million a year.
Romney said he considered that an assessment or a fee, not a tax. The distinction is important to Romney, who many expect to tout the healthcare plan on the stump as he moves toward a possible presidential run, because he would suffer politically if Republican antitax advocates determine that he supported a tax increase.
House Speaker Salvatore F. DiMasi and Senate President Robert E. Travaglini, who have been at odds over some aspects of the plan, stood side by side yesterday during a State House press conference and proclaimed the final bill a true compromise reached after many hours of give and take.
''This is a very historic moment in Massachusetts," DiMasi said. ''We will be able to -- in three years, hopefully -- virtually insure every man, woman, and child in this commonwealth."
The House and Senate are both expected to pass the plan today.
The most contentious part of the negotiations had centered on what mandates to include: a requirement on individuals to obtain insurance, on businesses to provide it, or a combination of the two. In the end, DiMasi said, the bill calls on individuals, businesses, and the state and federal governments to do more to bring healthcare to the state's 500,000 to 600,000 uninsured residents.
Legislative leaders say their plan would:
Cover 92,500 people by bringing more people onto MassHealth, the Medicaid program, by expanding eligibility for children and enrolling eligible adults who haven't yet signed up.
Cover an additional 207,500 people by offering free or low-cost private health insurance with sliding-scale premiums.
Cover an additional 215,000 by allowing businesses and individuals to purchase health insurance with pre-tax dollars and by creating incentives for insurers to offer low-cost products with fewer benefits.
Under the bill, the new insurance plans would be offered and run by private companies but be subsidized by the state. The poorest residents would have their premiums and deductibles completely paid for. Those with higher incomes would pay based on what they could afford.
The bill also creates an entity to administer the new subsidized healthcare program and to help businesses and individuals find suitable plans.
As for the requirement on individuals, those who don't get coverage would first lose their personal income tax exemption. Eventually, they could face a yearly fee to the state equal to half of the lowest-cost available insurance plan.
''No other state in the country has advanced healthcare to this degree both in coverage and quality, and it's something that I think every member of the Legislature will be able to be very proud of," said state Senator Richard T. Moore, an Uxbridge Democrat and lead Senate negotiator.
The plan calls for $58 million in new state spending over the rest of this fiscal year, which ends June 30, and $125 million each in the following three fiscal years.
The final bill also affords Romney something he desperately wanted: the power to veto individual sections of the bill while approving others, which means he can pick and choose what he wants to be included. His comments, though, suggested that he approves of most of the bill.
''Today, Massachusetts has set itself apart from every other state in the country," Romney said. ''An achievement like this comes once in a generation."
He stopped by DiMasi's and Travaglini's offices before his press conference to thank and congratulate them.
One question that remains is whether the state has moved quickly enough to satisfy federal officials who had threatened to end $385 million in annual federal Medicaid funding. Massachusetts needed to demonstrate substantial progress in reducing the number of uninsured to continue getting the money, and federal officials had urged the state to have a plan in place by January. (A primary state and federal goal is to vastly reduce demands on the so-called free care pool at hospitals, which the uninsured rely on when they get sick or hurt.)
Romney said he was confident the state would still receive the federal money.
DiMasi and Travaglini addressed reporters yesterday with the six members of the conference committee that hashed out the deal after a last-minute push over the weekend. Almost everyone who spoke alluded to how difficult it had been to finish negotiations, which had broken down at one point.
''I have to tell you all that I'm surprised we're here," said Senate minority leader Brian P. Lees, an East Longmeadow Republican and a member of the conference committee.
US Senator Edward M. Kennedy, who has worked closely on the bill with Romney and House and Senate leadership, said yesterday that he felt that a sense of history propelled lawmakers through difficult negotiations.
''I think a lot of people in the health community understood that this was a special moment and we shouldn't lose it or miss it," Kennedy said in an interview. ''I found that at the end of the day, when it really counted, [legislative leaders] were inspired to do the right thing."
The bill was met with mostly cautious optimism from groups that have been involved or tracking it closely.
''There are still important questions about affordability and long-term sustainability that are of critical importance to the people of Massachusetts, but there is no question that a spirit of generosity and respect for the dignity of the person is written throughout this bill," the Rev. Hurmon Hamilton of Roxbury Presbyterian Church, president of the Greater Boston Interfaith Organization, said in a statement.
John McDonough, executive director of Health Care for All, called the agreement ''very promising" and said it could obviate the need for a ballot question this fall that seeks health coverage for virtually all citizens.
A few groups, though, said they had concerns. The Retailers Association of Massachusetts, for example, is worried that the bill won't do much to bring healthcare costs under control for small businesses, said president Jon Hurst.
The agreement could be important in other areas, too. The healthcare debate has created a bottleneck for other bills. Several major pieces of legislation, including bills on economic development and overhauling welfare, await resolution.