State governors want Congress and President Barack Obama to pay more attention to their concerns as they renew efforts to reform healthcare.
The governors, who have been meeting in the U.S. capital this weekend, will make their case to Obama on Monday that some reform proposals could deepen the budget woes that many states face.
On the other hand, they also fear that doing nothing will also worsen their financial situations.
The meeting with Obama comes on the same day that the president is expected to unveil new proposals to advance legislation to change the country's $2.5 trillion healthcare system. On Thursday, he will hold a televised summit with Republicans to discuss ways to break the logjam.
The reform effort stalled in January when Republicans won a Senate seat from Massachusetts, giving them the 41 votes needed to block legislation with procedural barriers.
We're going to be the ones saddled with fixing this problem, said West Virginia Governor Joe Manchin, a Democrat, during a roundtable at the National Governors Association meeting. We're saying, get us into the game.
The governors fear that forcing people to acquire health insurance, as the current reform legislation envisages, will add to their financial problems.
Medicaid, the healthcare program for the poor jointly administered by the states and government, is already one of the largest single budget items for many states. Governors fear more people will be forced to rely on the program if they are compelled to get health insurance.
Adding mandates is going to add costs, said Rhode Island Governor Donald Carcieri, a Republican whose northeastern state has one of the country's highest unemployment rates.
In North Carolina, every new dollar added in revenue in coming years will go to pay for Medicaid, Governor Bev Perdue, a Democrat, said. Currently, the state is dipping into its general fund to cover healthcare costs, taking money away from education and other basic services.
The stresses that healthcare has placed on states' budgets mean the government should not delay in improving the system, she said.
I don't want Congress to say on this issue, 'we can wait another year,' she said.
Many governors say they deserve to be heard because of lessons they have learned from experiments in their states. Both Vermont and Massachusetts, for example, have their own state-wide healthcare plans. In the 1990s, Tennessee created its own plan, which, according to Democratic Governor Phil Bredesen, grew too expensive to administer.
A lot of these reforms pay for themselves, said Pennsylvania Governor Ed Rendell, a Democrat.
Almost all governors say electronic health records could help drive down costs. Obama included money in the stimulus plan passed last year for electronic record keeping in many states.
Most states do not expect to see any economic recovery until 2012, making it tough to find cash to pay for any new programs.
(Reporting by Lisa Lambert, editing by Alan Elsner)