Governors Call for More Leeway to Launch Reform

IMPATIENT with Washington's health-care calendar, governors asked Sunday for more leeway to launch their own reforms and demanded that the federal government stop making states pay the medical bills of illegal immigrants.

The governors also planned debate on a far broader immigration-policy statement demanding that the federal government pick up the tab for educating children who are illegal immigrants and for imprisoning illegal immigrants who commit crimes.

``The only reason why these immigrants are within the country is because of the failure of the federal government to control the border,'' Gov. Pete Wilson (R) of California said in arguing that states should not be held responsible for costs associated with illegal immigration.

The health-policy changes endorsed by leaders of the National Governors Association included a fresh, more sharply worded attempt to convince Congress to give states more power to tax and regulate health-care plans offered by big corporations.

The changes reflected the governors' sentiment that for all the talk in Washington about health-care reform, much of the work is done at the state level. While eager for the federal government to set a minimum benefits package and rein in health-care costs, particularly in government programs, the governors believe that the solutions to many other health-care problems is for Washington to get out of the way.

Yet even as they endorsed their new policies, many governors predicted that Congress would rebuff them.

``I don't have any great confidence when it comes to Congress that they will act quickly or prudently,'' said Gov. Tommy Thompson (R) of Wisconsin.

Governor Thompson was most pessimistic about the chances for the immigration proposal. Currently, states have to pay up to 50 percent of the costs when illegal immigrants get emergency medical care. And because children born in the United States are citizens -

even if their parents are in the country illegally - governors said the costs go well beyond emergency care.

Governor Wilson, a leading force in getting the governors to press their immigration concerns with the federal government, said his state's spending on health care alone for illegal immigrants has increased 18-fold in four years. Education and prison costs related to illegal immigrants have ``simply exploded'' as well, he said.

``We are no longer able to provide needed services to legal residents,'' Wilson said. ``That is totally unfair.''

In addition to Wilson, Gov. Ann Richards (D) of Texas and Gov. Lawton Chiles (D) of Florida voiced support for the new policies. They and other governors hope to enlist President Clinton's support for their effort during meetings with him scheduled for yesterday and today.

Many Republicans in the governors' organization sought even more changes in health-care policy - to reflect their opposition to the employer mandates and powerful regional health-care alliances in Mr. Clinton's health-reform proposal. Traditionally, the group's organization policies reflect consensus, and several Democratic governors loyal to Clinton blocked the GOP efforts.

``There's a lot of frustration and anger about this health-care plan,'' said Thompson, as he entered a governors-only luncheon to discuss that and other issues.

In asking for more leeway, foremost in the governors' minds was the Medicaid program, whose costs rose 31.3 percent in 1992 and 28 percent in 1991.

Now states must ask for a waiver to bypass federal regulations and enroll Medicaid recipients in managed care and other programs that save money by providing preventive care. The governors want to be able to adopt such programs without having to go through what they consider a burdensome waiver process.

For years, the governors have complained that their hands are tied by the Employee Retirement Security Act of 1974. The law limits the power of states to regulate or tax the health benefits of companies that self-insure their workers, which is the case for roughly 50 percent of workers in private industry.

Without the power to regulate the health plans of major employers, governors said they were hamstrung in proceeding with statewide health-care reform. Again, however, they were not optimistic that Congress would look favorably on their request, because of deep opposition from major corporations and labor unions.