Valerie Brown has a front-row seat to the hottest policy debate in the United States.

And the longtime Sonoma County Supervisor sits down at that policy table behind a new nameplate: President of the National Association of Counties.

She was sworn in during NACo’s meeting in Nashville in late July.

“When Obama took office, we realized we were perfectly positioned,” Brown said of her involvement with a NACo Task Force on Health Care Reform in the last couple of years.

“Our principles are in place and we could deliver that to the policy leaders. Because we were in offense mode, not defense mode, we were invited to the table.”

Brown, a former state Assembly member and mayor of Sonoma, spoke to in a cell-phone interview from the Nashville airport.

“We are really focused on access,” said Brown. “People need to get in to see a doctor and get in to get their medication. We need systemic change to allow for that. If you concentrate on a prevention and wellness model, you’ve got to have primary care physicians in place.”

NACo leaders have ideas on how to incentivize placement of doctors to underserved areas, too, Brown said.

She and her NACo colleagues are bringing local and county perspectives to health care, based in part on three hearings the working group held, including one in Sacramento. The debate will be informed by NACo ideas about access, expansion of Medicaid and coverage of children, Brown said.

NACo reps have been collaborating with health care policy people from the White House Office of Intergovernmental Affairs and the office of House Speaker Nancy Pelosi of California.

The task force’s policy ideas are solid. “As a national organization, you’re only as good as the policy put in place by your committee,” said Brown. “We carry our passion into Congress and the administration and we have made a difference.”

NACo is ensuring that the feds are aware of health reform initiatives from the county level, including the Healthy Kids Sonoma County program. The program, administered by Sonoma County’s Department of Health Services, makes sure local kids are signed up Medi-Cal and state health insurance programs, and extends county coverage for some kids whose families’ incomes exceed the state limits.

It’s a locally developed program in which the county collaborates with local health care providers and community organizations.

During her presidency, Brown said, NACo will intrude itself into the federal policy debate on environmental sustainability. “We are essentially left out of policy discussions where local government ought to be front and center,” Brown said in her acceptance speech to the NACo convention in Nashville.

Many local governments are innovating in such areas as wind and solar energy in joint projects with private industry, she said. Many counties are modeling “green” buildings with ambitious installations of photovoltaic solar panels.

This is also a hot debate inside the Beltway. A month ago, the Waxman-Markey climate bill passed in a close vote in the House of Representatives and awaits action in the Senate. The bill would establish a “cap-and-trade” system to empower businesses, organizations and governments to buy, sell and trade permits limiting emissions of greenhouse gases.

As president of NACo, Brown succeeds Don Stapley of Maricopa County, Ariz.