Nearly a dozen years of painful social services lessons in Utah will likely be a factor in Mike Leavitt's confirmation hearings and possible tenure as the country's top health and human services administrator.
Utahns most familiar to the landscape of health and human services contacted Monday said Leavitt's history as governor here make him a mixed-bag selection back there.
During his 11-year tenure as Utah governor, Leavitt was trampled by an inadequate and even dangerous child welfare system. Circumstances and lawsuits cost the state more than $3 million in legal fees and at least $50 million in new money to fix social service programs.
He was also forced to quickly learn about an overstrapped Medicaid budget that wouldn't stretch far enough to meet the needs of the very poor or the disabled. He also had to deal with escalating health-care costs and the implementation of welfare reform.
When Leavitt stepped down as governor, he said human services which he had rarely mentioned in his election campaign had taken more time and more effort than any other sector of his administration.
"He said today (Monday) he intends to move President Bush's vision forward," said Rob Ence, executive director of the Utah branch of the American Association of Retired Persons.
"That causes pause, because sometimes the vision of this administration is predetermined before they allow their experts or their secretaries in the Cabinet to speak. I worry about his ability to impact policy given the ideology of the administration."
"You can count on Leavitt for a robust and productive decision-making process," said Utah Issues' Judi Hilman, a health policy analyst for the research center.
A decade ago, Hilman said Leavitt brought that "robust" approach to Utah health-care issues when he established the Health Policy Commission.
"In the brief life span of the commission, he tried to look at a full range of challenges, some of which were very difficult and stubborn."
On the flip side was the creation of a program Hilman characterized as a "disaster" the state's Primary Care Network.
Leavitt was able to obtain from his HHS predecessor, Tommy Thompson, a waiver for Medicaid spending that allowed the state to essentially take some benefits away from the very poor in favor of insuring more people with a limited benefit package.
"It was a trade-off some people found very disconcerting," said Leighton Ku, a senior fellow with the Center for Budget and Policy Research.
Advocates worry that by Bush tapping Leavitt, a similar "block grant approach" is of high interest by the White House as a way to reduce Medicaid costs.
"By choosing a governor involved in that, it signals where this administration is going," Ku said.
Leavitt's nomination comes just as the federal government is preparing to roll out the first-ever prescription drug benefit for seniors and the disabled who are on Medicare insurance.
Scott Williams, executive director of Utah's health department, said he believes Leavitt's history here actually strengthens his nomination.
"I think he gained a lot of experience with health issues when he was governor," Williams said. "He started with some knowledge because he was in the health insurance industry but learned more with Medicare/Medicaid, disaster response and state's response to immunizations."
While Williams concedes Leavitt was unable to solve the problem of the uninsured, a key factor to approaching the problem is flexibility.
Some observers say the state has a somewhat inflexible attitude toward child welfare that has caused it to still be dealing with a decade-old class-action lawsuit.
The suit, filed in 1993, claimed children in foster care are inadequately cared for and even endangered. The state has paid $3 million in attorneys fees and ponied up more than $53 million in new money to improve its child welfare system.The case is settled and the state has made significant progress toward improving its handling of child abuse cases, the court-appointed monitor has said. But significant progress is yet to be made before he recommends oversight end.