US Health nominee seeks changes in care for poor

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President George W. Bush’s pick for Health and Human Services secretary, Mike Leavitt, called on Wednesday for changes in the nation’s Medicaid program for the poor to make it more effective and efficient.

“We can manage what we have better (in Medicaid),” Leavitt told the Senate Finance Committee at his confirmation hearing. “We can expand access,” he said, adding that if states get greater flexibility they can devise ways of providing more people with at least some basic health care.

"I believe Medicaid is not efficient ... changes need to be made,” Leavitt said, adding: “I am anxious to see them (made) as fast as they can.”

Leavitt, the head of the Environmental Protection Agency and a former Utah governor, was praised by both Democrats and Republicans who said he will win easy confirmation within a few days. Plans to approve him at the committee level were foiled when snow prevented some senators from arriving to vote.

A separate Senate committee on Health, Education, Labor and Pensions unanimously backed his nomination, although the Finance Committee has final jurisdiction.

Medicaid, the joint federal-state health care program for the poor which also covers many elderly nursing home patients, looks set to be a major source of controversy this year, with many health care experts anticipating that Bush’s budget next month will call for spending caps or turning the federal share into a block grant to states.

“There’s been considerable speculation” about caps or block grants, Maine Republican Sen. Olympia Snowe said. “I hope we don’t see any proposals in that direction… I think it would be a mistake to go down that road.”

Leavitt was asked repeatedly about block grants and avoided answering directly several times. When pressed hard, he finally replied, “I know of no block grant proposal that would come to you.”

But at other points in the hearing, he mentioned that he was not yet privy to all White House plans and on several occasions he differentiated between the core Medicaid population that states must cover by law, and other “optional” groups that states can choose to incorporate.

Bush a few years ago proposed what was essentially a block grant system that would apply to the optional groups. That was controversial even among congressional Republicans, and many Republican state governors also oppose it. 

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