President Bush promised yesterday to collaborate with the nation's governors on a plan to restructure Medicaid, but administration officials and governors expressed pessimism that they could reach quick agreement on a package of cost-saving changes in the health care program for the poor that Bush's budget targets for $60 billion in cuts over 10 years.
"We want Medicaid to work . . . but we also recognize that the system needs to be reformed and we want to work with you to do so," Bush told the governors at a morning White House meeting.
President Bush is seeking governors' assent to Medicaid changes that would cut $60 billion over 10 years.
Health and Human Services Secretary Michael Leavitt has pushed governors to embrace a series of program changes to save money and has urged them to move quickly to present a united front on Capitol Hill. Although governors of both parties described the tone of the White House meeting as positive, there was clear skepticism about reaching an agreement, particularly among Democrats.
"Getting it right is more important than getting it quick," said Virginia Gov. Mark R. Warner (D), chairman of the National Governors Association. "And I think that while we'd love to be able to resolve everything today, we don't anticipate that that's realistic."
An administration official said agreement could be weeks or months away. "It's only the beginning of the discussion, very much so," said the administration official, who spoke on the condition of anonymity to be more candid. Despite hopes for a quick deal, the official cautioned against expecting that there is an agreement "that could be decided this week or in the next 12 weeks."
Bush did little of the talking about the program, whose rapid growth has severely strained state budgets and which governors of both parties say must be restructured to save money and provide better health care for low-income Americans. Instead, he left the heavy lifting to Leavitt, the former governor of Utah, who enjoys widespread credibility among his former gubernatorial colleagues.
But governors said they are wary of making a deal without knowing more about whether they can fend off cuts the size Bush has recommended in his new budget. Kansas Gov. Kathleen Sebelius (D) said that governors are alarmed by those recommendations and that a proposal that simply calls for cutting the budget is a non-starter. "There's a reluctance to cut the budget before we get some agreement on the budget numbers," she said.
After their White House meeting, governors of both parties met privately for a more extensive discussion of the issue. They will resume their talks today, when Leavitt is scheduled to appear at the winter meeting's final session.
Massachusetts Gov. Mitt Romney (R) said governors from both parties face the same problems, as rising enrollment and growing health care costs have forced state executives to squeeze the program in the past few years. But he said governors are divided over strategy.
"Do we move in the next couple of weeks with some proposed reforms to try and help in the short term or does that forestall the kind of fundamental reform that has been discussed?" he said. "We're trying to decide what's the right strategy legislatively."
Iowa Gov. Tom Vilsack (D) said Leavitt told the governors that "there is not as much desire in the halls of Congress for a Medicaid debate and discussion" as there is in the states and that progress will require a consensus solution from the governors and the administration.
"Some of us are concerned about pushing our product too quickly and getting ourselves into a position where we lock ourselves into a number, rather than looking at a broad array of reform that in turn will drive the budget number," he said.
New Mexico Gov. Bill Richardson, chairman of the Democratic Governors Association, said cuts in the Medicaid program are likely, noting that "the Democratic governors are outnumbered."
Richardson and many other Democrats said they believe Bush and Leavitt are negotiating in good faith, but Montana Gov. Brian Schweitzer (D) called the administration inflexible. "I heard, 'We're going to cut, and this is how we're going to change the programs,' " he said.
Arkansas Gov. Mike Huckabee (R), the NGA vice chairman, said Bush's proposed cuts "have our undivided attention" but stopped short of giving Bush's budget a clear endorsement. "We recognize the president's concerns in dealing with the federal deficit," he said. "We face those kinds of problems at the state level. But we also have to weigh that against the issues of services for people."
Staff writers Ceci Connolly and Brian Faler contributed to this report.