Republicans in Virginia's House of Delegates plan to make controlling Medicaid costs a central part of their agenda when the legislature convenes in January, members said after a closed-door meeting Sunday.

Virginia, like most states, is faced with spiraling health care costs for the poor, the elderly and children. The increases threaten to eat up much of the surplus generated from the state's healthy economy.

So Republican lawmakers are considering legislation that would seek to lower costs without cutting benefits.

"It's probably the fastest-growing part of our general fund budget," said House Speaker William J. Howell (Stafford) at a meeting of the House Republican Caucus at the GOP's state headquarters here. "We've got to get ahold of it."

The most dramatic change to Virginia's health care system, according to a written summary of the GOP proposals under consideration, would be the creation of health savings accounts for Medicaid patients.

Under such a proposal, government-sponsored insurance for those on Medicaid would be replaced by medical checking accounts that patients could use to pay for their health care. The idea, according to lawmakers, is to empower patients to seek out the most economical health care.

"What a lot of people are suggesting is just nibbling around the edges, not looking at the core program," Howell said.

The Republicans are also considering changes that would increase the use of electronic medical records, change Medicaid oversight, provide long-term care tax credits, increase the use of managed care for Medicaid patients and privatize parts of the system.

Many of the Medicaid changes under consideration would require waivers from the federal government, which finances half of the health care program. Several other states, including Florida and South Carolina, have received waivers to experiment with similar changes.

In Virginia, the proposals face skepticism among some health care advocates for the poor and the elderly. Health care savings accounts, which are a favorite idea among conservatives, require significant effort by patients to seek out and compare doctors, hospitals, procedures and specialists. Some health care experts say Medicaid patients are not the best equipped to do that.

In addition to discussing the Medicaid proposals, House Republicans voted by acclamation to reelect their leadership for another two years. The Republicans voted to retain Del. H. Morgan Griffith (R-Salem) as majority leader, Del. M. Kirkland Cox (R-Colonial Heights) as majority whip and R. Steven Landes (R-Augusta) as caucus chairman.

The group also voted to nominate Howell again, virtually guaranteeing him another two-year term. The entire House will vote on Howell's nomination the first day of the session, Jan. 11.

In their first meeting since the Nov. 8 election, the returning Republicans congratulated four new GOP members. They also praised Del. Robert F. McDonnell (R-Virginia Beach), who leads the attorney general race against Sen. R. Creigh Deeds (D-Bath) by about 345 votes but faces a recount.

The group took no action on comments by House Democrats, who said they deserve an additional member on all permanent committees. Democrats gained a seat in the election. They will have 39 members. Republicans will have 58, and there are three independents.

In a statement last week, Democratic Caucus Chairman Brian J. Moran (Alexandria) said he has heard "rumors" that Republicans were considering amending House rules to prevent Democrats from gaining seats on committees.

"This kind of power grab will certainly make bipartisanship more difficult and would set the stage for a very bitter session," he said.

But Griffith said Democrats, who controlled the legislature for decades, shouldn't be talking about fairness.

"I don't remember them being very bipartisan when they were in control," he said. "They never stood up for proportional seating when we were in the minority."