"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.

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E-mail: amyjoi@desnews.com