Governors Urge New Approach to Health Care Reform : Medicine: Task force’s plan stresses gradual change at the state level over quick federal action. Proposals now in Congress draw skepticism.

SEATTLE —  The nation’s governors Saturday called for attacking the country’s health care crisis by stressing innovative reforms at the state level rather than pushing for swift and direct action by the federal government.

The attitude among the governors, expressed in policy recommendations by a health care task force, became apparent at the opening session of the annual summer meeting of the National Governors’ Assn. Congressional leaders and Bush Administration officials joined in the deliberations on the health care issue, which is the centerpiece of the four-day conclave.

The governors’ emphasis on a gradual, state-level approach to the problem, created by soaring health care costs, has been shaped in part by their recognition of the political reality that the Administration seems unwilling to offer or back any new policy initiatives in this area.

But it also reflects a skepticism by governors on the health care task force, Democratic and Republican, concerning a range of legislative measures introduced by Democratic members of Congress to expand and strengthen health care coverage.

The task force’s 120-page report, called “A Healthy America: A Challenge for the States,” was released here Saturday, along with policy recommendations that the full association will vote on Tuesday.

Although the governors have tried to deal with this complex problem on a bipartisan basis, Saturday’s discussion took on the aura of presidential politics because of the prominent involvement of Arkansas Gov. Bill Clinton, a Democrat who is co-chairman of the task force. Clinton is considered a likely candidate for his party’s presidential nomination and is seen as one who favors limiting the party’s traditional stress on government activism. His remarks Saturday were consistent with that outlook.

At the meeting’s opening press conference, Clinton said it was unlikely that any “national solution” to the health care problem could be reached in the next year or so. He thus contended that the federal government, by relaxing its various mandates on the way states run and fund their Medicaid programs, should give them broad freedom to design “radically different” solutions to health care problems, especially the need to control costs.

Before undertaking a “tax-and-spend approach” by the federal government, Clinton said, “we think there should be some structural reform, and we think the states should lead the way.”

In answer to a reporter’s question, Washington Gov. Booth Gardner, another Democrat and the outgoing chairman of the association, denied that the task force’s recommendations amounted to a call for a “moratorium” on federal action while the states tested new solutions.

But Republican Gov. John Ashcroft of Missouri, who will replace Gardner as head of the association at the end of this meeting, told the Associated Press: “I’m certainly not prepared to endorse any of the (health care) bills that are there (in Congress).”

Clinton voiced skepticism about the practicality of the major Democratic legislative proposal in the area, introduced by Senate Democratic leaders, that would extend health insurance to the 34 million Americans now lacking coverage by requiring all employers either to offer insurance to their workers or to pay a tax into a fund that would cover workers otherwise unprotected.

“My opinion is that if you pass a law (to extend insurance coverage) . . . which does nothing to deal with the underlying growth and inefficiency of the American health care system . . . we will solve one problem without solving another problem. We still might have runaway costs,” he said.

Clinton said it would be “presumptuous” of him to tell the senators that “they should wait 10 years to pass that bill.” But he said his advice to sponsors of such legislation in general is: “Don’t do it unless you’re willing to get some cost controls into it.”

Monica Healy, an aide to Senate Majority Leader George J. Mitchell (D-Me.), disputed Clinton’s implication that the Senate proposal, called “Health America” and backed by Mitchell, lacked adequate cost-control provisions. She pointed to five pages of provisions that she said call for reducing unnecessary care and eliminating unnecessary administrative costs.