Utah Gov. Mike Leavitt and three fellow governors were ready Wednesday to propose Medicaid reforms. But they waited a half-hour, then an hour, an hour and a half and finally 100 minutes before their Senate hearing finally began.
It was delayed while the Senate was busy with a series of slow, complicated floor votes on other matters. It was a perfect metaphor about how states feel the federal government often inadvertently blocks or delays their ideas on improving Medicaid."States with aggressive health reform efforts are stymied by out-of-date federal regulations," Leavitt told the Senate Finance Committee. "The rules and regulations don't bear any relationship to reality."
With Leavitt leading the trumpeting, Republican and Democratic governors unitedly told Congress that Medicaid - the federal-state system to provide health care to the poor - is broken, and states should be given more control to help fix it.
But Republican and Democratic governors differed whether GOP proposals to turn over control of Medicaid entirely to the states with federal block grants to help cover costs is a good idea.
Leavitt, chairman of the Republican Governors Association, likes block grants because of the greater flexibility they are designed to give states.
"I have discovered that this country's governors do not have the authority needed to reinvent how this vital health-care program can best meet the needs of its citizenry," Leavitt said.
For example, he said Utah found Medicaid provides more bene-fits than most workers receive from private health plans offered by employers. So he wanted to reduce benefits from 130 percent of average to 118 percent to allow giving more people access to Medicaid with the money saved.
"What we believe to be a common-sense decision was not allowed under the existing system," he said. "We need the ability to make those hard decisions."
But Democratic Vermont Gov. Howard Dean, chairman of the National Governors Association, opposes block grants - saying the federal government should remain an active partner in the federal-state program, but still give states more flexibility.
Dean wants changes to simplify complicated rules on figuring out payments to providers and wants to make it easier for states to obtain waivers for unique programs that may improve service.
Democratic Florida Gov. Lawton Chiles also questioned whether GOP block grants would really help states. He worried formulas for them may give all states the same growth rate, which could hurt states with greater-than-average growth in recipients - which he said would likely include Utah and Florida.
But Illinois Republican Gov. Jim Edgar said block grants would slow the growth in federal spending and help balance the federal budget by taking advantage of savings that states are sure they can achieve if given the opportunity.