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 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.