Provider groups, which last year vigorously fought a federal balanced-budget amendment in Congress, will now concentrate on stopping such a constitutional change in the state legislatures.
The reason for the switch in tactics is the Republican sweep of the November congressional elections. Last year, provider lobbyists say, the amendment was destined for a close vote with Democrats controlling the House and Senate. However, with Republicans taking over Congress, lawmakers are almost sure to approve an amendment next year and send it to the states for ratification.
Thirty-eight states must ratify a proposed change in the U.S. Constitution.
"Our assumption is that the balanced-budget amendment will pass; we think it's going to be a slam dunk," said Tom Nickels, vice president of federal relations at the American Hospital Association. "It is tough to fight it at a federal level, but we hope that once it becomes more of a reality at the state level and states start to realize how much this will cost them, the tide may turn."
According to an estimate by incoming Senate Budget Committee Chairman Pete Domenici (R-N.M.), a balanced-budget amendment, which Mr. Domenici opposes, would require more than $600 billion in federal spending cuts during the next five years. The federal budget now totals more than $1.5 trillion annually.
Mr. Domenici, Republican governors and state legislators say they fear a balanced-budget amendment could cause Congress to foist responsibility for many expensive programs onto the states. The governors and state lawmakers recently told GOP congressional leaders they would support an amendment only if it included a provision that would prevent the federal government from passing the cost to the states.