The candidates for the north country’s House of Representatives seat have had a lot to say about Medicare, the federal health care program for the elderly.

They’ve had very little to say about Medicaid, the federal health care program for the poor.

Rep. William L. Owens, D-Plattsburgh, and Republican Matthew A. Doheny of Watertown, who will face off on Tuesday, differed on what they would do to help the program save money. The program is one of the major cost-drivers for county governments, and it’s helping add to the fiscal crisis on the national level.

The program covers 62 million people below or near the federal poverty level, and is also one of the major revenue sources for nursing homes. The poverty level income for a family of four is $23,050. Broadly speaking, Mr. Owens said that the program should focus more on preventive care to save money, while Mr. Doheny said that Medicaid should be turned into a block grant program so that states have more flexibility to determine who qualifies for the program.

“I think everybody agrees we should be cutting costs,” Mr. Owens said. “That has to be done in a way that results in better healthcare outcomes, as opposed to just cost-shifting.”

He said he wasn’t sure whether he’d agree to changes to the program that would result in reduced benefits to Medicaid enrollees. He said that Medicaid should offer health savings accounts. A health savings account works by first figuring out how much it usually costs to cover somebody of a certain age. Say that figure is $10,000. If the person’s health care costs are $8,000 over a year — the result of keeping up with blood sugar tests or exercising regularly — they can keep $1,000, while the government will save $1,000. If the costs exceed $10,000, the patient would owe nothing and receive nothing, Mr. Owens said.

Such a program would reward people for staying healthy and save money, he argued.

Rep. Paul Ryan, R-Wisc., who is running for vice president with Mitt Romney against President Barack Obama and Vice President Joe Biden, authored a budget in 2011 that included dramatic changes to the Medicaid program.

The program would be changed into a block grant program, while also changing funding so that states don’t get increased funding for increased costs, but instead increased funding based on population, according to a report in The Atlantic. According to a study by the Kaiser Family Foundation, Mr. Ryan’s proposal would reduce federal Medicaid funding by 38 percent, or $810 billion over 10 years.

Mr. Owens said he doesn’t support the plan, because it would make millions ineligible for Medicaid health insurance, according to studies.

“If they are not covered, they’re being treated when it’s more expensive, when they’re sicker,” he argued.

Mr. Owens voted in favor of President Obama’s health-care overhaul, which will offer money to states so that they increase the number of people eligible for the Medicare program, up to 133 percent of the poverty level, according to the Washington Post.

Mr. Doheny, on the other hand, said that he supported a block grant program for Medicaid, but didn’t necessarily agree with Mr. Ryan’s reduction in Medicaid spending or the change in the way it gives money to states. And he said that he doesn’t necessarily think the federal government should spend less money on Medicaid.

He said that making the program a block grant and easing federal rules over who is eligible for Medicaid in each state will help create “50 laboratories of democracy.”

A block grant, as opposed to the current Medicaid system, is essentially a pool of money without many requirements attached.

States right now can make the program more generous, but they have minimum levels set by the federal government; New York, for example, has one of the most generous programs in the country. So giving more states leeway to change their eligibility rules wouldn’t likely change much in New York.

“It’s the federal mandate that flows through the state that hits people right in our towns and counties,” Mr. Doheny said.

Mr. Doheny supports repeal of President Obama’s health-care law, which would in effect roll back that Medicaid expansion. That would save almost $1 trillion, though supporters of Mr. Obama’s law say that the measure is deficit-neutral.

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