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Kristin Murphy, Deseret News
The former Health and Human Services secretary and former Utah Gov. Mike Leavitt speaks at the annual national conference of editorial writers at the Hilton in Salt Lake in Salt Lake City on Friday, August 25, 2009.
States have far more influence than one would initially think on solving the problems of health care in the country. —Mike Leavitt, former Utah governor and U.S. Health and Human Services Secretary

DEER VALLEY — There's plenty that states can do to steer the direction of health care reform, former Utah governor and U.S. Health and Human Services Secretary Mike Leavitt told the Western Governors Association Saturday.

"States have far more influence than one would initially think on solving the problems of health care in the country," Leavitt said, despite the focus on the federal Affordable Care Act, widely known as Obamacare.

Leavitt, now the chairman of a Utah-based health care consulting firm, said while overseeing the world's largest health care payer under President George W. Bush, he quickly realized he had more power as a governor to make changes easily.

States, Leavitt said, have control over health care in a number of areas, including managing plans for state workers, administering Medicaid, governing the practices of medical professionals and regulating insurance.

Governors can use those tools to help control health care costs, he said. "Frankly, governors have the tools to accomplish that — tools that the federal government pretends to have but simply does not," Leavitt said.

Utah Gov. Gary Herbert pointed out during the panel discussion at the association's annual meeting that governors had no role in developing the nation's new health care reform law championed by President Barack Obama.

"We've been so ignored," Herbert said. "I think we could have made it better."

Herbert also questioned whether the nation can afford the cost of the health care reform law. He cited what he said would be a $3.2 billion price tag over a decade if he chooses to expand Medicaid in Utah as allowed under the new law.

Idaho Gov. C.L. "Butch" Otter said he and legislative leaders have already made that decision, but are still waiting for waivers from the federal government to require more personal responsibility among recipients and attention to treatment outcomes.

Leavitt said federal bureaucracy is not as much to blame as ideology. But he still urged the governors who decide to accept the Medicaid expansion initially paid for by the federal government to "do it on your terms."

Utah is one of only a handful of states that has not made a decision on Medicaid expansion yet. Herbert told the Deseret News after the panel discussion he expects to make a recommendation when he releases his annual budget in December.

"I'm getting some people who want me to expand it. Others say, 'Wait a minute,'" and cite concerns over benefits that may become available to higher income families, the governor said.

"That's all some of the stuff we're trying to factor and weigh and consider. It's not black and white with me. It has nothing to do with politics," he said. "This really will end up being a decision made on what is in the best interests of all of Utah."

Herbert said Utah is considering options other than simply accepting the proposed expanded coverage, suggesting there could be a half-dozen or more possible alternatives.

"This is going to have long-term ramifications," he said. "We understand the need. We need to make sure we can afford it and need to make sure we're not causing ourselves, for short-term gain, a long-term problem."

Also Saturday, the western leaders from the United States and Canada participated in a panel discussion on education. Former Colorado Gov. Roy Romer, who also headed the Los Angeles school district, said education is a tough issue for governors.

"One of the jobs is to try to manage the future," Romer said, noting an investment made in public education now may not pay off for decades. "It's difficult for us to assume responsiblity for a 20-year spectrum. But I ask, 'Who else is?'"

Romer also made a pitch for the Common Core State Standards, which were rejected recently by Utah Republicans at their state convention for promoting an "un-American and inferior" school curriculum.

"Common Core is simply the process of defining, step-by-step, grade-by-grade, how good is good enough for your child to compete," Romer said. "This is a magnificent tool."

Romer, a Democrat, told the governors not to "let the far left, the anti-test people, say we want to kill it. And don't let the far right say it's government trying to tell us what to do."

The Western Governors Association's three-day meeting ends Sunday, following a discussion of energy development in the region. About 400 people are attending the meeting, being held at the Montage resort.

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