The state's major HMOs are joining patient advocates and health care professional groups in support of a 50-cent cigarette tax increase to raise money to expand health care programs for the poor.

The insurers, Blue Cross and Blue Shield of Massachusetts Inc., Tufts Health Plan and Harvard Pilgrim Health Care Inc., spent about $4 million this year to defeat a ballot measure calling for universal health care and managed care reform. But they said they are supporting the cigarette tax because it is a part of their mission to expand access to health care. ``We recognize our responsibility to help working adults gain access to health care, and that's why we're supporting the (health care expansion) campaign,'' said Susan Leahy, a Blue Cross spokeswoman. Insurers and other opponents argued that the ballot initiative would have forced premium hikes and could have cost the state millions of dollars.

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