The Pepper Commission's plan to guarantee Americans access to health care would have little effect on large and medium-sized companies because they already provide generous health benefits to their employees, say some risk managers and benefits experts.

In that sense, "it's not going to have any impact on us," said Kathy Dupree, director of employee benefits for medium-sized Metrovision Inc., a cable television company based in Atlanta, Ga.While benefits experts applauded the plan's attempts to address the problems of rising medical costs, there was concern that the plan does not go far enough in addressing the high cost of health insurance.

Costs have to be controlled before the problem of the working uninsured can be solved, said Patricia Wilson, a principal at A. Foster Higgins & Co., a Philadelphia, Pa.-based employee benefits consulting division.

The comments were made in response to the plan approved recently by a bipartisan congressional panel known as the Pepper Commission, after the late Rep. Claude D. Pepper, D-Fla.

The blueprint in question would require employers to offer health benefits to their workers or contribute to a government fund designed for that purpose. Minimum standards for insurance coverage and medical care would be set by an new federal agency for health care policy and research.

"We would not scale down our benefits, to meet the government's minimum standards," said Metrovision's Ms. Dupree.

Furthermore, "I'm not sure that it's going to meet the problem for the nation at large," she continued.

"No one is willing to deal with spiraling (health) costs" as an issue unto itself, she said.

"Universal benefits are (merely) a band aid," said Ms. Dupree. They do not attack the cause of the problem.

"The real issues are cost, access and quality," said Karen Ignagni, director of the employee benefits department of the AFL-CIO. No one union or company can reduce costs on its own, she said.

"We need national negotiations with providers to provide a strategic plan."

Ms. Ignagni echoed the Pepper plan's recommendations by calling for national practice guidelines - a sort of handbook to tell physicians what procedures to use for different medical problems.

She said that despite all their training, doctors need help making decisions because of the "explosion of information and progress in medical care." They "find it difficult to keep up."

Ms. Dupree agrees that "doctors' fees have to be controlled (but) you don't want to tie a doctor's hands either," she said.

Ms. Ignagni said that physicians should not be "micro-managed" but believes that "we need accountability," from doctors.

Practice guidelines could help bring down medical malpractice premiums, she said.

"The Pepper Commission has provided a blueprint," Ms. Ignagni added. ''Business can no longer ignore this issue."

Howard Greene, acting director of governmental affairs for the Risk Insurance and Management Society in New York City, said the corporate insurance buyers' group would oppose the plan ifthe level of mandated health- care benefits were not kept to a minimum.

It should not be a "Cadillac plan," that would require coverage for non- basic types of health problems such as mental health care.

Ms. Dupree said that generally speaking she doesn't like the idea of federally mandated benefits. But a federal plan may be "socially necessary," she added.