BOSTON -- The nation's governors attacked Senate Minority Leader Bob Dole's health care reform bill yesterday, saying his proposal to cap federal payments for Medicaid represents a huge and unacceptable cost shift to the states.
"Governors could not be more united in their opposition to this proposal," said a bipartisan group of National Governors' Association leaders in a letter sent to congressional leaders on Wednesday and released here yesterday.
"This action imposes a significant unfunded mandate on states and could result in state budget crises," said the governors' letter. It was signed by Republicans Carroll A. Campbell Jr. of South Carolina, the association chairman, and Tommy G. Thompson of Wisconsin, and Democrats Howard Dean of Vermont, the group's vice chairman, and Roy Romer of Colorado. Mr. Thompson and Mr. Romer co-chair the association's health care leadership panel.
Medicaid is financed jointly by states and the federal government. If the government puts a limit on its share, the states would have to make up the difference, the governors said.
"That would be the worst of all the things that could happen," said Florida Gov. Lawton M. Chiles Jr. Limiting the federal government's share for Medicaid would cost states an estimated $150 billion dollars over the next eight years, the Democrat said.
At their 86th annual summer meeting here, the governors were complaining about the so-called "unfunded mandates" from the federal government.
"This would be the largest unfunded mandate we have seen in a long time, and we don't need that," Mr. Romer said.
Mr. Dole's proposal, an alternative to the bills being pushed by President Clinton and the Democrats, is co-sponsored by 40 of the 44 Senate Republicans. Under the plan, the government's savings in Medicaid would be used to help low-income families with medical coverage.
The governors want to see health care legislation passed but don't plan to lobby for any specific bill. Still, their stand could hurt Mr. Dole's position as the Kansas senator enters a crucial period in his battle against the White House. The Clinton administration is considering an all-or-nothing strategy that would rely on Democratic votes to pass the president's plan rather than accept a compromise on key features.
Stressing the need for the passage of health care reform this year, Senate Majority Leader George J. Mitchell of Maine warned the governors that, if the legislation fails, Congress may soon find runaway federal spending on Medicaid and Medicare an irresistible target. And that, he said, "will devastate your state budgets."
Mr. Clinton and Mr. Dole are scheduled to address the governors at the final session of the three-day meeting tomorrow.
In Maryland, Medicaid costs have been rising at an annual rate of 10 percent to 12 percent, even in recession years when budget cuts reduced services, said state Health Secretary Nelson J. Sabatini. In the state's $13 billion budget, $2 billion has been allocated for providing medical care to the poor, half of it in federal funds and half from state taxpayers.
Oklahoma Sen. Don Nickels, chairman of the Republican Policy Committee, said that Senate Republicans understand the states' concern on Medicaid spending but that the bills pushed by the Democrats represent unfunded mandates of another sort. Referring to Mr. Clinton's proposed requirement that all employers pay at least 80 percent of the cost of health insurance for their workers, he said, "That is an unfunded mandate on private business."
Such a mandate, he said, would drive up costs to businesses and result in a loss of jobs. Mr. Mitchell disputed that, saying the effect on jobs would be "neutral."
While Mr. Dole's plan received the brunt of comments, the Democrats were not entirely untouched. The governors criticized the House Ways and Means Committee's health bill, the basis of a measure being drafted by Majority Leader Richard A. Gephardt of Missouri for a debate on the House floor. That proposal would dramatically expand part of the Medicare program to provide insurance to those who are not now covered, placing them in a federal program in which the government sets the rates to be paid. The governors said the committee's proposal would simply put 40 percent of Americans in a costly, government-run entitlement program.
The governors also:
* Agreed to urge Congress to merge any new subsidized health insurance program for low-income Americans with the existing Medicaid program to avoid separate eligibility or other requirements.
"We don't want two low-income programs," said Mr. Campbell, noting that the governors are the ones who will have to implement whatever Congress ultimately passes.
* Agreed to oppose so-called "any willing provider" laws at the federal or state levels. Such measures, such as one that died on the floor of the Maryland Senate in the 1994 legislative session, would require HMOs or other "managed care" networks to accept any physician who wants to join.