State governors seek solutions for Medicaid

WASHINGTON -- Governors say the national program that guarantees health care for the poor bears much of the blame for their states' financial woes.

State leaders, however, disagreed Sunday on whether President Bush's proposed changes for Medicaid will help the situation or make it worse.

In Washington for their annual winter meeting, members of the National Governors Association are hoping to present a united front on transportation needs, homeland security funding, Medicaid and more. But partisan politics is threatening their goal.

Democrats charged that the Bush administration was trying to squelch an open dialogue with the president. Republicans complained that NGA proposals are more reflective of Democratic views than a bipartisan approach.

President Bush welcomed the governors and their spouses at a formal dinner Sunday evening at the White House's state dining room, where an orchestra provided classical music during the meal and country singer Lyle Lovett was to perform later.

"Governors are strong leaders with a practical point of view," Bush said during his toast. "I'm really grateful that my former fellow governors are serving this country."

Kentucky Gov. Paul Patton, a Democrat, offered a toast to Bush's leadership. "As your former colleagues and your closest partners in our federal-state partnership, we know you have great burdens," he said. "Tonight we stand together, shoulder to shoulder, beside you and behind you."

Today, governors were to return to the White House to meet with Bush and administration officials on policy issues. Several Democrats, however, said the White House planned to allow just two questions that had to be approved before that meeting. White House officials promised a wide-ranging exchange.

"The White House should not try to control what the nation's governors should do and say," said Democrat Bill Richardson of New Mexico.

From the GOP side came criticism of the association's leadership and staff for what Republicans said was a Democratic bias on policy issues.

Republican Bill Owens of Colorado cited the choice of actor and director Rob Reiner, a Democratic activist, as a speaker. Reiner leads a foundation to improve early childhood education. "Partisan politics is alive and well at the NGA," Owens said.

Republicans on the association's executive committee later set aside a formal proposal to ask the federal government for immediate fiscal relief directly to the states.

"You can't just keep printing money," said Republican Jeb Bush of Florida. "That policy position was partisan. It was the position of big government."

Bush said an overhaul, rather than a federal bailout, was the best way to address the rapidly rising costs of Medicaid, the state-federal program that guarantees health care to 44 million poor people.

The system will not work much longer without sweeping changes, said Republican Bob Taft of Ohio. "We simply can't sustain 10 percent to 15 percent growth continually."

But others, many of them Democrats, said they worried that the president's proposal would worsen the problem because it promised more money up front and less down the road.

"I have grave concerns about what it does in the out years," said Democrat Janet Napolitano of Arizona. Her state brings in the same revenue this year as four years ago, but it helps pay for a half-million more people on Medicaid.

"Down the road, am I leaving a billion-dollar problem?" she said.

One change that all governors supported was to ask the federal government to pick up all costs of health care for the elderly poor who could be covered by Medicare, the federal program for people 65 and older, but are now covered by Medicaid. They estimate that could equal $80 billion, a third of all Medicaid costs.

The Bush Medicaid proposal offers states that choose to participate more flexibility in coverage and services offered. The president is proposing an additional $3.25 billion next year and $12.7 billion over seven years, but would lower spending in equal measure in the following three years.

The administration's proposal would not affect the poorest people, whom states are required to serve. The flexibility would allow states to expand or limit services to other people that states can add to Medicaid at their discretion, including children and pregnant women with incomes just above the poverty line.

It also gives states more leeway on optional benefits -- notably prescription drugs, dental and vision care and some services for the elderly -- that could be limited under the proposed program.

Two new governors discussed their own plan to lower prescription drug costs.

Democrat Jennifer Granholm of Michigan and Republican Jim Douglas of Vermont announced last week that they would join in a purchasing pool to leverage lower prices on prescription drugs, one of the fastest rising costs of health care.

"The more you buy the more you can negotiate a lower price," said Granholm, who added that she's talked with a half-dozen governors who were interested in joining them. "This is a bipartisan effort."

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