Governors on Health Reform

July 19, 1994

The nation's governors have sent Senate Republicans and Democrats on the House Ways and Means Committee a useful reminder about health care reform realities. As officials who have to deal with the consequences not only of what they do but what Congress does to them, their message is, "Please, no more unfunded federal mandates."

Senate minority leader Bob Dole is the most immediate target of gubernatorial criticism. His alternative to the Clinton health plan currently calls for a cap on federal spending for Medicaid, with added costs in this mushrooming program to be dumped on the states. Since Medicaid is already a budget-buster in most state capitals, the Dole formula was sufficiently distasteful to draw bipartisan condemnation at the National Governors Association meeting in Boston this week.

Bipartisan criticism also is focusing on a pending Democratic proposal in the House that would vastly expand the Medicare program to include millions of lower-income citizens. Again the governors fear new federal entitlements that the states will have to finance, and are voicing their complaints.

With Congress scrambling to conclude health care reforms before its pre-election recess in August, the collective voice of the governors assembled in Boston comes none too soon. Last February, they effectively killed off the Clinton plan for government-run alliances to provide universal health insurance. Instead, they called for more modest approaches with the proviso that if Congress can't act it should at least give the states more flexibility to devise their own programs. If anything, the Boston meeting finds the governors more impatient with Washington but also being pushed, almost against their will, into partisan posturing.

How this all works out, and what impact the governors will really have on the whole reform debate, will be determined in part on their reaction to speeches today by Senator Dole and President Clinton. The Republican leader, who would like to run against Mr. Clinton in the 1996 presidential elections, has indicated he will have some ideas to to ease gubernatorial concerns. As for President Clinton, he is not fully committed to the House Ways and Means rewrite of his health reform legislation and may welcome a modest rebuke to the committee's Medicare scheme. In any event, gubernatorial input should help clarify key issues as the national health debate nears its climax.

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