``There's an imperative for change out there," said Michael O. Leavitt, secretary of health and human services, who asked governors yesterday to join President Bush in demanding nationwide standards on medical quality and information-sharing. ``The system is moving."
The fall elections also are a major topic at the three-day gathering of the National Governors Association, which opened Saturday. Thirty-six states will elect governors this fall.
Governor Mitt Romney, who is attending all three days of the conference, made a presentation to the governors on how states respond to emergencies of various types, according to spokesman Eric Fehrnstrom. He also attended the session on the states' role in healthcare.
These are among the signs of change on healthcare:
Massachusetts created universal health insurance by requiring everyone to carry insurance, with a combination of subsidies and penalties to make coverage more affordable and encourage people to buy it.
Florida tried to rein in costs, starting in two large counties, by shifting many Medicaid recipients into private managed care. Medicaid recipients choose a managed care group to coordinate their care and the state pays a premium to the group. Companies will get more money for sicker patients.
West Virginia aims to encourage Medicaid families to make healthier decisions and save money by reducing benefits if they refuse to sign contracts promising to show up for doctors' appointments and use the emergency room only for emergencies.
Most programs are not yet in place or too new to assess whether the change is for better or worse, or even if they work. The overhaul in Maine -- which brings state and businesses together to get more people on insurance -- by Governor John Baldacci, a Democrat, is one of the oldest, though so far has failed to enroll the numbers of uninsured that it aimed for.
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