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2 different views of health care reform // FROM TALLAHASSEE

When state Sen. Ginny Brown-Waite was appointed to lead the Senate's Health Care Committee last month, she pledged to "make Florida's health care system the envy of the nation without breaking the bank."

No simple task for a state that is bracing for a major reduction in the federal government's projected spending on Medicaid and Medicare.

In a recent interview from her Hernando County office, Brown-Waite outlined some of her ideas about reforming the state's health-care system.

She said her main priorities are to make it easier for consumers to have access to information about their physicians, expand the operations of county public health units, extend insurance to the uninsured and provide better screening of Medicaid patients.

Brown-Waite, a former Hernando County commissioner, has long had an interest in health care issues. In the 1980s, she worked as a staff director handling health and other social issues for the New York Senate. She was elected to the Florida Senate in1992 and became a member of the Health Care Committee a year later.

Senate President Jim Scott appointed Brown-Waite, a fellow Republican, to head the Health Care Committee after the former chairman, Alberto Gutman, R-Miami, resigned after reports about his ties to the HMO industry.

As chairwoman, Brown-Waite coordinates meetings of a committee that examines everything from standards for septic systems to hospital regulations and the operations of HMOs.

First, she wants to give consumers better access to information about physicians, such as how often they have been sued or disciplined. While such information can be obtained now, it is often hard to get. "You get transferred around so much," said Brown-Waite, 52. "The bottom line is, you need to be a cautious consumer today. . . .

"One of the other things I'm looking at is that when physicians are disciplined and their licenses are taken away in other states, I want to make sure that we don't welcome them with open arms in this state."

Like other Senate Republicans, Brown-Waite has opposed Gov. Lawton Chiles' proposal to provide subsidized health insurance for as many as a million of Florida's working poor. By steering more Medicaid patients into managed-care plans, Chiles has said the state could save $8-billion over five years. Those savings would be used to develop a plan offering low-cost insurance to employees of companies without insurance.

"I don't presently see the need for a special session if the governor is unwilling to look at stronger, more substantive ideas for health care reform," Brown-Waite said in the news release announcing her appointment as committee chairwoman.

Yet Brown-Waite says she supports developing a plan for providing better care to the uninsured.

How? By, among other things, including more small businesses in community health purchasing alliances, and expanding hours and operations of public health units.

The public health units are important because of their emphasis on preventive care, but they are underfunded and their hours are limited, she said.

"Let me tell you, and not all the Republicans agree with me, I think we should subsidize the working poor," Brown-Waite said. "They are the people who, out of frustration, historically have thrown up their arms, particularly women with children who have day-care costs and may not have child support. They are still working and trying to keep their heads above water."

The state, she says, could finance a plan for covering the uninsured by saving money in two key areas: first, through a better screening of Medicaid patients to ensure that the elderly are not placed unnecessarily in nursing homes, when they would be better off in less expensive assisted-living facilities or receiving help at home from a home health care agency; and, second, by steering more Medicaid patients into managed-care plans like HMOs.

Brown-Waite said she did not support Chiles' plan because of the way HMO Medicaid contracts previously have been set up. Under the old contracts, the costs of Medicaid HMOs were higher than those of the traditional fee-for-service Medicare program. HMOs spent too much on administration, didn't have a balanced patient mix, and didn't focus enough on preventive medicine.

In recent months, however, the Agency for Health Care Administration changed its parameters for HMO Medicaid contracts to address some of those problems. As a result, the new contracts offer lower fees, suggesting that real savings can be achieved, Brown-Waite said.

What does she think about the GOP plan in Congress to overhaul Medicare and Medicaid?

She gives it "lukewarm support." The cuts "are too steep as far as Medicare goes," and she agrees that more consideration needs to be given to Florida's high proportion of seniors and those below the poverty level. She doesn't agree with a provision that would allow physicians to refer patients to clinics and businesses in which they have investments.

On the other hand, Brown-Waite accused some Democratic leaders of spreading misinformation about the GOP plan and said, "If we didn't do something the system would totally shut down." She also said that converting Medicaid into block grants gives the state more flexibility to steer beneficiaries into lower-cost HMOs.

"I don't see state legislators turning their backs on those who need medical care," she said.

_ Information from Times files is included in this report.

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