By ROBERT TANNER
AP National Writer
In the nation´s capital, the crisis dominating discussions is Social Security. In the 50 state capitals, the crisis is Medicaid, the state-federal health care program for the poor that has seen its caseload and costs soar.
Governors brought a mixed message to a meeting with President Bush and his Cabinet on Monday: Republicans and Democrats alike are bucking the president´s budget cuts to Medicaid, while embracing some of his reforms and pushing for federal willingness that would allow states to experiment more.
Bush has sought $40 billion in savings in the health care program. Much of that would come from stopping states from using certain accounting techniques to draw down federal Medicaid funds. The administration contends the states are exploiting loopholes that cheat taxpayers.
Those cuts will cause severe problems at home, governors said. “I don´t think there are any divisions among governors” on the spending reductions, said Ohio Gov. Bob Taft, a Republican. “The real issue is it´s governors against the White House and Congress.”
At the same time, governors of both parties attending their annual winter meeting say the $300 billion-plus, 52 million-patient program is growing too fast to continue with the status quo. It´s time for bigger reforms.
Their line echoes the stance of Health and Human Services Secretary Mike Leavitt, a former Utah governor. Leavitt spent much of the two days leading up to the White House meeting trying to win support for Bush´s budget proposals and hear governors´ concerns, according to governors and Leavitt aides.
But consensus was elusive on either sweeping support or sweeping reforms. So far, governors agreed only to oppose the cuts and tentatively embrace elements of the budget plan that aim to drive down drug prices and discourage the middle-class elderly from relying on Medicaid for nursing home care.
Rather than spending dollars and political capital revamping Social Security, Bush should consider deeper changes to Medicaid, the nation´s single largest health care program, several governors said.
“From where I sit, Medicaid and Medicare are much more pressing issues,” said Arizona Gov. Janet Napolitano, a Democrat.
Governors want to see a greater willingness from the federal government to allow for widespread experimentation.
“The common ground that I do believe we´re finding is, we´ve got to reform not just pieces of the system but the whole concept of Medicaid,” said Republican Gov. Mike Huckabee of Arkansas.
The program is exploding because of demographic changes driving more and more elderly onto the program, which cares for two-thirds of the nation´s nursing home residents. Rolls are swollen, too, when private employers drop health care for employees, who turn to the state.
Leavitt´s complaints that taxpayers are being cheated by state accounting loopholes are misguided, said Michigan Gov. Jennifer Granholm, a Democrat.
Such practices don´t fatten state coffers, she said. “This money is going directly to help pregnant women, children _ vulnerable people,” she said. “Enough is enough. It is immoral to force cuts which will result in people being taken off health care who are vulnerable.”
Medicaid enrollment jumped 40 percent in the past five years, and spending has soared, too. From 2001-2004, Medicaid spending grew by more than 50 percent. For states, that growth has meant that state spending on Medicaid has overtaken the amount spent on K-12 education.
Leavitt has maintained that it´s time for an “uncomfortable, but necessary conversation” between the federal government and the states on reining in the system.
Governors say they´re willing _ but only if the changes spur efficiences, and don´t simply push the costs to the states. They´re promising a full-scale lobbying effort in Congress to get legislators to see things their way.
The president and first lady Laura Bush were hosts at a White House dinner for the governors Sunday night.