First, Medicaid pays providers at such low rates (roughly 72 cents for every dollar Medicare pays) that a huge chunk of the nation’s physicians refuse to treat new Medicaid patients outright. The trend begs the question: What good is health coverage if no one accepts it?

And second, as The Washington Post points out today, state budgets are so squeezed already that governors are reluctant to adopt any new financial burdens, even if it means getting health coverage for more residents. (Although Medicare is subsidized exclusively by the federal government, states are on the hook for a percentage of Medicaid costs.) Indeed, many governors oppose the Medicaid expansion in the Finance bill.

“I can’t think of a worse time for this bill to be coming,” said Tennessee Gov. Phil Bredesen (D), a member of the National Governors Association’s health-care task force. “I’d love to see it happen. But nobody’s going to put their state into bankruptcy or their education system in the tank for it.”

Medicaid is difficult to analyze, because the 50 states and the District of Columbia each have different payment structures and eligibility rules. In poor states, for example, the federal government picks up a larger percentage of the tab, relieving the burden on state coffers.

Also, some states have taken it upon themselves to expand Medicaid to cover a larger portion of their low-income population. Maine, for example, covers parents up to 206 percent of the poverty level, while many other states have kept Medicaid largely focused on kids, disabled folks and pregnant woman — the populations they’re required to cover under federal law. Indeed, in 34 states, parental Medicaid eligibility is set below the federal poverty level.

The differences in programs complicate the push for universal uniform. The Finance Committee’s bill would expand eligibility enormously, in effect offering coverage to every American earning less than 133 percent of poverty ($14,404 a year), including childless adults, who are currently prohibited from participating. That provision has been skewered by those states facing the largest enrollment hikes because they don’t already cover many adults.

The Finance bill (as amended) also requires states with expanded coverage to maintain those heightened eligibility levels for pregnant woman and the disabled above 133 of poverty until state insurance exchanges become operational, which is expected to occur at the start of 2013. That maintenance of eligibility requirement has been blasted by the states with the most generous Medicaid programs, which wouldn’t have the option of dropping higher-income adults if the budget situation worsened.

The Finance Committee is expected to approve the larger health reform proposal this week. But you’d be crazy to think that the debate over Medicaid won’t resurface in a big way when the bill moves to the Senate floor.

We are not going to be hampered by ideology in trying to get this country back on track. We want to figure out what works [...]

If you can show me something you are doing that’s working, or if you tell me that this program or this regulation is hampering us from doing smart things that will advance the interests of our state, then you’re going to get a ready ear. [Emphasis added.]

The remark drew applause from many of the governors, who probably can name a few environmental regulations or worker protections unpopular with business interests in their states.

But while the comment is surely less popular with liberal activists, they can probably take comfort knowing that Obama has a 96 percent lifetime rating from the League of Conservation Voters and drew broad support from labor unions during the primaries, as well as the general election campaign.

While he may be willing to listen to the governors and open to some changes, it seems unlikely that he would turn his back on the concerns of these core Democratic constituencies.

Politico’s Mike Allen has some excerpts from Obama’s prepared remarks, to be delivered today at the National Governor’s Association meeting in Philadelphia.

As president, I will not simply ask our nation’s governors to help implement our economic recovery plan. I will ask you to help design that plan. Because if we’re listening to our governors, we’ll not only be doing what’s right for our states, we’ll be doing what’s right for our country. That’s how we’ll grow our economy – from the bottom-up. And that’s how we’ll put America on the path to long-term prosperity. [Emphasis added.]

Economic policies targeted at those at the bottom, with the benefits intended to work their way up to the top? In America?

Throughout Washington, the heads of hundreds of conservative think-tankers are no doubt exploding simultaneously.

UPDATE: Obama just delivered the remarks, and he veered considerably from the prepared remarks sent to reporters. He omitted the line I highlighted above. Perhaps he saw it as too ideological or antagonistic, or he simply forgot it. However, it will be very interesting to see to what extent his administration’s economic policies reflect that principle.

In the video, Obama reiterated his campaign pledges for quick and dramatic action on global warming, and vowed to partner with any governor, nation or company willing to work on the issue.

The video also demonstrates Obama is being somewhat selective in avoiding sending mixed messages to foreign leaders. Not that this is necessarily a bad thing — in this case, quite the contrary. But his position on taking action on climate change is clearly at odds with that of the current administration.