A few weeks ago, Governing sat down with Michael Leavitt, the U.S. Health and Human Services secretary and former governor of Utah, to talk about changes that could be in store for the Medicaid program. Here are some key points he made.

Saving Medicaid: It is not sustainable. Governors are the key to reform. No one cares about Medicaid as much as governors do. For members of Congress, it's just a budgetary matter. Governors have to find consensus on the things they can agree on, go to Congress and break the door down and say, "We have to have changes now."

Ideas for Medicaid reform: Prescription drugs are an increasing part of the Medicaid budget. We need a better reimbursement statute.

Medicaid can't be a long-term-care strategy for the country. And it can't be an asset-protection plan.

Everybody in Medicaid has to be cost-conscious. There should be co- pays in certain populations and benefits tailored to different groups.

States shouldn't need a waiver to use home and community care with the long-term population.

The importance of health IT: Let's assume that the economists are right, and there's a 30 percent redundancy in the half-trillion dollars of annual health care expenditures. That's $500 billion a year. If government programs and private employers adopt common health IT standards, then IT will be as transforming in health care as the Internet was in telecommunications. People will have better information. Markets will emerge that weren't possible before. We'll have a consumer-driven market where the system will help us make choices.