New York Times
as printed in the San Jose Mercury News
Sunday April 4th, 1993

   FLORIDA REVAMPS HEALTH-CARE SYSTEM

   Plan combining competition, regulation
   Reflects Clinton's ideas for controlling costs



  TALLAHASSEE, Fla.- The Florida Legislature approved a sweeping overhaul
of the state's overburdened health-care system early Saturday, making Florida
the first state in the nation to combine free-market competition and
government regulation in a way similar to the Clinton administration's plans
for controlling soaring medical costs.

  Overcoming obstacles posed by lobbyists who sought to gut the proposal
with hundreds of amendments, Gov. Lawton Chiles, the author of the plan,
won bipartisan support for his package after three days of marathon
deliberations in the State Capitol.  Chiles also had threatened to call 
lawmakers back for a special session if the plan was voted down.  The
difficulties the governor faced provide a glimpse into the resistance
that President Clinton is likely to confront in his reform efforts.

  Proposed As Model


  Childes said he hoped Florida's embrace of a system of managed competition,
in which many people and businesses buy health care from organized networks
of doctors and hospitals, would be a model for other states as well as
Washington.  "We would like to be able to chart the way for the federal 
government," he said.

  Other states have taken steps toward broad changes in their health-care
systems including Hawaii, Oregon, Vermont and Minnesota.  But Florida's
plan, combining coverage of all residents with a far-reaching effort to 
control health costs, is taking place on a larger scale than anything
seen elsewhere.


  Spurred Into Action

  In part, Florida's lawmakers were pushed to act by soaring health-care
spending, which rose to $38 billion last year from $9.4 billion in 1980.
Another factor was the size and composition of the state's population.
Florida's 13.5 million residents include the nation's highest proportion
of elderly people, as well as large numbers of immigrants and rural and
urban poor.

  As lobbyists representing hospitals, insurance companies, doctors,
drug manufacturers, pharmacists, malpractice lawyers, laboratories
and other interests watched from the Capitol rotunda, both houses of the
state Legislature authorized the creation of 11 Community Health Purchasing
Alliances.  As envisioned by Chiles, these new state-chartered regional
cooperatives will help employers negotiate to obtain the best care at
the cheapest price and decide what kind of care plans can be offered on
the market.

  As a result, 2.5 million uninsured residents in the nation's fourth-most-
populous state should be able to obtain what Chiles has described as "full
access to quality, affordable health care."  People already enrolled in
health-care plans will be able to remain with those programs, although some
premiums are expected to rise initially.  Eventually, many insurers are
expected to participate in the purchasing alliances.