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2 different views of health care reform // FROM WASHINGTON

Spring Hill may seem like a long way from Washington, D.C., but Dr. Beatrice Braun is used to the commute.

As an officer on the national board of the American Association of Retired Persons, Braun, 74, spends a lot of time in the nation's capital these days.

A retired psychiatrist, Braun has been in the thick of the national debate over Medicare reform, speaking before congressional subcommittees and meeting with Florida's delegates about the proposed overhaul of Medicare, the federal health insurance program that covers 37-million elderly and disabled people.

She also has spent a lot of time outside of Washington, attending public forums on Medicare reform, listening to concerned AARP members around the country and even appearing as a guest on a CNN news program to talk about changes to Medicare. On Thursday, the House of Representatives passed a budget bill that calls for squeezing $270-billion out of Medicare over the next seven years.

Braun's message, and that of the AARP, has been unequivocal: Medicare needs fixing, but the cuts in the projected growth of Medicare are "too much too fast." Combined with planned reductions in the rate of Medicaid spending, the cuts will hurt Florida's poorest residents the most, Braun said last week from her home on Arbuckle Road in Spring Hill.

"We definitely want to fix Medicare so that it will remain solvent," Braun said. "But we know that what's being cut is a lot more than what's needed for solvency. . . .

"Are we destroying the social insurance concept that Medicare was founded on?"

Braun, a native of Philadelphia, has long had a concern for society's vulnerable. As a former nun and doctor, she provided medical relief to thousands of refugees during the Korean War.

After returning to the United States in 1968, she continued her medical education and became a psychiatrist and pioneer in the treatment of seriously ill mental patients.

Through her work in mental health, she met Dick Braun, a former Jesuit priest and psychologist. The two married after receiving dispensations from their vows to the church.

In 1989, the Brauns retired and moved from their home in Hastings On Hudson, New York, to Spring Hill.

Since then, Braun and her husband, who heads the Hernando chapter of Habitat for Humanity, have been active in the AARP. She became a volunteer in a program helping elderly Hernando residents process Medicare forms and file appeals. Then Braun became state coordinator for health services offered by the AARP.

Last year, she was elected to the national board of the AARP, where she serves as secretary. The 21-member board consists mainly of retired professionals representing a cross-section of the group's 33-million members. The non-profit group lobbies on behalf of, and provides various services to, people 50 and older.

Braun has two broad criticisms of the Republican Party's plan for Medicare reform: that it will reduce the quality and affordability of health care for the elderly, and that the projected savings from the reforms are unrealistic.

Under provisions in the overall budget bill passed last week by the Republican-dominated House, the current monthly premiums for Medicare Part B premiums would increase from $46.10 to $53.40 by January 1996 and to $87.60 by January 2002.

The GOP plan, aimed at keeping Medicare solvent until at least 2006, sets tight spending limits on Medicare, gives retirees incentives to join lower-cost managed-care programs such as HMOs and reduces reimbursements for hospitals and doctors.

President Clinton has said the Medicare cuts go too far and has threatened to veto the bill, if it passes the Senate.

Braun agrees and says the public was not given enough time in congressional hearings to respond to the plan. The AARP wants Congress to cut $110-billion from Medicare _ what Medicare trustees said would be necessary to assure the program is strong for the next decade _ and then consider long-term changes in the program that would address the needs of the soon-to-retire baby boom generation.

Too much of the GOP plan relies on untested practices, Braun contends.

While she supports giving Medicare recipients more choices, she doesn't think health maintenance organizations have developed a track record when it comes to covering retirees, and doubts they will produce the kind of cost savings the GOP anticipates. "HMOs don't have enough experience with seniors," she said.

Proposed medical savings accounts, which would offer high-deductible catastrophic coverage, haven't been used much in the private health care market, Braun said. There is a danger that such a plan would siphon off the healthy and wealthy, leaving the other options with higher risks and costs.

Paring Medicare reimbursements to hospitals, already struggling with low reimbursement rates, will only hurt quality of care, as will eliminating federal nursing home standards, Braun said.

In addition, the Medicare overhaul will make health care less affordable for the elderly, she said.

"Spending reductions of this magnitude will fall heavily on beneficiaries," Braun said before the House Committee on Commerce in August. "If we assume that half of the required reductions would come directly from beneficiaries _ $3,400 would be added over seven years in premiums, deductibles and co-insurance to an already extraordinary out-of-pocket burden."

The adverse effects on low-income elderly would be compounded by the proposed $170-billion in Medicaid reductions, also contained in the House budget bill, Braun said.

Medicaid is a joint state-federal program that provides health care for low-income people. The program serves about 40,000 nursing home residents in Florida.

The GOP budget would convert funding for Medicaid and other social programs into block grants to the states. The idea: States would have more flexibility to spend money as they want.

The problem with that approach, according to Braun, is that certain federal requirements aimed at guaranteeing assistance to the poor would no longer be assured. For example, the bill would eliminate the current Medicaid requirement that states pay Medicare deductibles and co-insurance for low-income seniors.

Moreover, there will not be enough money to cover everyone, Braun said. That's especially true in Florida, she said, because the formula for distributing Medicaid money does not adequately address Florida's growth rates and high concentration of retirees, she said.

Despite a last-minute deal to provide additional money for the state, Democratic analysts estimate Florida will lose $12.4-billion over the next seven years in Medicare and Medicaid money.

"We think of it as all separate programs," Braun said. "But it's the same person getting hit on the head. . . . It is certainly the poor and the near-poor that are getting the most impacted."

_ Information from Times files is included in this report.

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