The scheme was approved by the Bush administration, which issued Utah a first-of-its-kind waiver to use Medicaid money for the program.

Advocates for low-income people assailed the move because it cost the state's poorest residents most dental, vision and mental health benefits.

But Utah bureaucrats say the Primary Care Network (PCN) represents the kind of visionary thinking that makes Leavitt the perfect pick to head the U.S. Department of Health and Human Services (HHS). They paint the 53-year-old former insurance executive as a futuristic, compassionate conservative with an eye toward making government more efficient and accessible.

"We will see somebody who has a strong interest in really understanding issues and who rejects a one-size-fits-all approach," predicted Utah Health Department Director Scott Williams. "He doesn't rely a lot on advisers."

But advocates for children, the elderly, poor and disabled are less enthusiastic about President Bush's choice. They say that though well-intentioned, PCN was short-sighted and an example of another big idea that Utah's second-longest-tenured governor never saw through because he lacked experience and political will.

"This is a time for ingenuity for how to cover the uninsured. I hope we can get it. But if what we can look forward to is more policies like PCN, then we're in big trouble," said Judi Hilman, a health policy analyst for Utah Issues, a nonprofit working to address poverty in the state.

Hilman said giving states broad flexibility on Medicaid spending undermines the entitlement aspect of the program, "which, though as painful as it is to fund, is absolutely essential."

Salt Lake City Democratic Rep. Roz McGee points to Leavitt's HealthPrint as another "bold" reform that never panned out.

Introduced his first year in office, the idea improved patient access to specific benefits and services, but it didn't contain costs or improve access to quality care as promised, McGee said. "Utah would have been a wonderful laboratory. But other than installing Utah's Childrens Health Insurance Program and helping to keep Medicaid solvent while rationing health care, I can't speak to a whole lot of innovation."

Medicaid and health care reform loom large in the nation's consciousness and the Bush agenda. But Leavitt's key accomplishments come in the areas of child welfare and welfare reform, having overseen major overhauls of both systems.

Even so, he is far from a national leader in those fields, said John O'Toole, director of the Oakland, Calif.-based National Center for Youth Law (NCYL). "I'm skeptical of his ability to administer such a large department, because I never saw him do that effectively in Utah."

NCYL is responsible for the David C. v. Leavitt lawsuit that in 1993 alleged Utah's child welfare system was so mismanaged it violated the constitutional rights of every child in state custody.

Rather than fight it out in court, Leavitt settled the lawsuit and signed an agreement leading to massive reforms that continue to drive the budget and operations of the foster care system.

But as O'Toole point out, Utah is still out of compliance with the agreement, because the state "has resisted and resisted and resisted" through legal appeals and other stall tactics.

Robin Arnold-Williams, Utah's Human Services director, admits "the agency wasn't in good shape."

But she said "we're on track" to comply with the agreement and applauds Leavitt for working quickly to fix the underlying problem: overworked and under-trained caseworkers.

Leavitt found funding to double those ranks. "Kids and families are safer today because of that leadership," said Arnold-Williams.

Raylene Ireland, Utah Workforce Services director, also credits Leavitt with improving Utahns' access to welfare benefits and job training.

Elected in 1992, Leavitt inherited a jobs program composed of six separate agencies delivering 23 programs that he combined into one umbrella organization overseeing 37 one-stop service centers statewide.

"So when someone came in needing help finding a job, a case manager could put them in touch with other services," Ireland said.

The Cato Institute, a non-profit public policy research foundation headquartered in Washington, recently gave Utah's welfare reform efforts a failing grade, noting that the state's poverty rate has risen over the years.

But landing a minimum-wage job with no benefits only makes things worse for the working poor, Ireland said. Utah's system aims at helping the poor access education and life skills needed to stay off welfare permanently.