Tens of thousands of people without health insurance -- many of them young, healthy, and able to afford coverage -- would be required to get insurance, just as they must now carry auto insurance, under a healthcare bill being written by House lawmakers.

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House Speaker Salvatore F. DiMasi told the Globe yesterday that he backs a healthcare insurance requirement, a stance that aligns him with Governor Mitt Romney and significantly boosts the idea's prospects on Beacon Hill. The third major player in the healthcare debate, Senate President Robert E. Travaglini, has said he is open to the idea but has not committed to it.

If Massachusetts forces its citizens to purchase health insurance, it would be a national pioneer: No other state has such a requirement. A study released recently by the Urban Institute argues that it would be impossible to cover the Bay State's uninsured without requiring individuals to buy coverage.

Lawmakers are still settling the details, such as how much income a person would have to earn to face the insurance requirement and how the government would enforce it. DiMasi said he would like to protect lower-income people from the requirement. The House is also weighing a major expansion of Medicaid to cover more low income people.

In an interview with the Globe yesterday, DiMasi said the House plan ''will make people take personal responsibility when they are able to purchase health insurance for themselves and their families."

The Romney administration estimates that about 200,000 of the state's roughly 500,000 uninsured make enough money to afford private insurance with some state help. Romney has said that many of them are young, male, single, and simply gamble that they won't get sick. If they do, they go to hospitals and receive care they never pay for, because the hospital and the state pick up the tab.

Romney, who has been much more detailed than DiMasi in describing his health plan, would apply the individual insurance requirement to everyone. He wants to combine the requirement with rule changes that would allow insurance companies to offer limited, low-cost policies, and wants to provide state subsidies to help low-income people buy the policies. Under his plan, residents who choose not to obtain health insurance would face tax penalties and even the garnishment of their wages.

''I don't see how it works without an individual mandate," Romney said yesterday.

DiMasi suggested the House will follow a similar approach when it comes to low-cost coverage and subsidies. But he said he is worried about instituting penalties that are too harsh.

''The mandates and enforcement can't put people into financial hardship when they are sick or in need of medical care," he said.

DiMasi said he is ''90 to 95 percent" sure that the plan the House members of the Joint Committee on Health Care Financing will produce at the end of the month will include the individual requirement. He said he is personally committed to the idea, and his opinion will carry a lot of weight when the full House debates the plan.

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Source:The Boston Globe