CHARLESTON, W.Va. -- Gov. Joe Manchin's support for federal health-care reform has come under attack as Republicans try to tie the U.S. Senate hopeful to President Obama, but those who have worked with the Democratic governor on state health issues say a closer look at his time in office reveals a fiscally conservative record with mixed results.
Health-care advocates say Manchin could do more in a state that struggles with poverty and high rates of health problems like obesity, smoking and diabetes.
Manchin's approach wins praise from the West Virginia Chamber of Commerce, which credits him with fiscal caution and promotion of personal responsibility.
During the national health-care reform debate, Manchin supported reform efforts, saying America's existing system is unsustainable.
The governor recently told the Gazette-Mail that he backed only certain provisions -- for instance, those that allow people with pre-existing conditions to get health care, or let young adults stay on their parents' health plans.
"I wouldn't have voted for the final version of that thing with the way that it came out," he said.
Manchin, who became governor in 2005, added that he wants "every West Virginian that gets up in the morning and goes to work to have affordable health care."
Health advocates, though, say they are disappointed that the governor has not embraced opportunities to insure more West Virginians through Medicaid, the state/federal health insurance program for the poor.
In his 2009 State of the State address, Manchin proposed using the program to expand coverage to more West Virginians, but he never did so.
West Virginia Medicaid's income-eligibility rules are some of the nation's most stringent, covering only parents who earn below 35 percent of the federal poverty level. That amounts to an income of about $6,000.
Most childless adults do not qualify for coverage. Proponents of Medicaid expansion, which was at the heart of federal reform efforts, say insuring more people helps cut down on expensive emergency-room visits and other health costs such as uncompensated care. The state gets matching federal funds for the program.
Still, health-care advocates give Manchin credit for helping expand coverage to needy kids through the Children's Health Insurance Program.
"That's been very positive, there's no question about that," said Perry Bryant, director of West Virginians for Affordable Health Care, which supported federal reform.
The governor also used federal money to launch the "Kids First" health-screening program for kindergartners, said Renate Pore, health policy analyst at the West Virginia Center on Budget and Policy.
Overall, though, Manchin's record is "a mixed bag," Bryant said.
His administration's redesigned Medicaid program sought to promote personal responsibility, but drew widespread criticism.
Early in his tenure, Manchin created a partnership to promote healthy lifestyles, but has not pushed to raise the state's tobacco tax, which is among the nation's lowest.
This year, his Department of Health and Human Resources proposed funding cuts to programs that fight diabetes, tobacco use and cardiovascular problems.
Also this year, Manchin used line-item veto power to slash $5.5 million from a Medicaid program that lets elderly and disabled people get health care in their homes. He later restored the money after an outcry from legislators.
Late last year, he pledged to prioritize a $24 million plan to fight drug and alcohol abuse, but never allocated any money for it because, he said, the state couldn't afford it.
House Health and Human Resources Chairman Don Perdue, D-Wayne, has sparred with Manchin on the in-home care program, other Medicaid issues, and substance-abuse funding.
"Any suggestion that Joe Manchin is an Obama-phile on health issues borders on lunatic," Perdue said. "Joe Manchin is extremely conservative. We have seen that throughout his tenure."
Perdue and some other lawmakers have questioned why Manchin has pushed for health spending cuts as the state's surplus Medicaid funds -- projected to be more than $300 million this year -- have grown. The governor says the extra money will be needed down the line, when major Medicaid deficits are expected.
Chamber of Commerce President Steve Roberts said he believes Manchin has the right approach to state health issues. The chamber has a representative on the council of the Governor's Office of Health Enhance and Lifestyle Planning, which coordinates the state's health-reform efforts.
"The governor has looked for ways to get more West Virginians covered without breaking the bank," Roberts said, adding that Manchin also has promoted the concept of personal responsibility in health. "That's the key."
Republicans likely will continue to attack Manchin on federal health-care reform as they seek to link him with Obama, an unpopular figure in West Virginia.
"[Manchin's] past statements speak for themselves," said Jim Dornan, campaign manager for Republican candidate John Raese, "and he can run as far and as fast as he wants to. The record is the record."
Raese wants to try to repeal the federal health-care reform law if elected. Dornan said Raese supports Republican proposals like tax breaks for people buying health insurance and allowing insurance to be sold across state lines.
Reach Alison Knezevich at alis...@wvgazette.com or 304-348-1240.
