(Host) Former Governor Howard Dean and incumbent Governor Jim Douglas are playing active roles in the national health care debate.

Dean supports many elements of a new health care bill, while Douglas opposes many of the same provisions.

VPR's Bob Kinzel reports.

(Kinzel) Douglas enters the debate wearing several hats. He's the governor of a state that's enacted health care reform, he's the chairman of the National Governor's Association and he's been the head of the NGA's health care committee.

Speaking on VPR's Vermont Edition, Douglas said he opposes the Democratic approach to health care because he doesn't think it will be effective in reducing costs.

He doesn't support the idea of creating a new public option and he says a compromise plan in the Senate that would allow individual states to opt out of the plan is no improvement at all.

(Douglas) "I can't believe that, like the stimulus money, any state is too likely to opt out. If there's a program that is available to other people around the country, then I expect states are going to go along. So I don't see that as a very serious departure from the public option initiative that we've seen already."

(Kinzel) Dean is a big supporter of a strong public option and he argues that dropping the plan from the bill means that an ineffective and expensive health care system will remain in place.

(Dean) "This makes no sense at all. It's basically a gimmick by the insurance industry to forcibly require Americans who want health insurance to go through their industry."

(Kinzel) The bill also expands eligibility in Medicaid to provide greater access to coverage for some Americans.  Medicaid is a shared responsibility between the federal government and the states.

Under the congressional proposal, the federal government would pick up all of the costs of the expansion for several years. Then states would be required to pay roughly 40 percent of the expansion expenses.

Douglas says he expects that state revenues will slowly rebound in the future and he wants to target this money for critical state programs instead of an unfunded federal mandate:

(Douglas) "I'm not sure that the first dollars we get when the economy expands ought to go into a federally mandated Medicaid expansion."

(Kinzel) But Dean says the benefits of expanding  Medicaid far outweigh the liabilities.

(Dean) "In principle I'm not for mandates that are unfunded. But I don't think this is an egregious crossing of the line. I think our citizens are going to have a huge benefit. Our small businesses are going to have a huge benefit. So while there's time to try to get that corrected, I don't think that's a reason not to support the bill."

(Kinzel) The U.S House is expected to vote on its health care bill before Thanksgiving.

For VPR News, I'm Bob Kinzel in Montpelier