http://sweetness-light.com/archive/lessons-from-hawaiis-health-care-systemRemember Hawaii’s Health Care LessonsJust 16 years ago Hawaii was held up as a model for national universal health-care. Now it is broke and even its vaunted employer mandated coverage is not guaranteeing everyone is getting coverage.
From the archives of the New York Times:
Hawaii Health Care Is Called a Model for U.S.
May 19, 1993
Hawaii’s universal health-care system, which insures 96.5 percent of the state’s residents and costs less than health care in other states and Canada, could serve as a national model, health officials from Hawaii say in a new report.
The report also says that requiring employers to provide insurance for employees who work at least 20 hours a week has not bankrupted small businesses, as some feared when the plan went into effect 19 years ago.
"In fact, some indirect indicators suggest that the effect may be positive," said the report, to be published on Wednesday in The Journal of the American Medical Association…
Hawaiians rank at or near the top in health status compared with other Americans, the health officials said.
"We believe a considerable amount of this success is attributable to direct and indirect effects of Hawaii’s employer mandate," they said, adding that the state’s approach receive serious attention as a task force headed by Hillary Rodham Clinton considers health-care changes…
Hawaii was also held up as as a model during the recent debate about expanding the federal State Children’s Health Insurance Program (SCHIP), since it was the only state universal child health care program in the country.
But that didn’t last too long.
From the Associated Press:
Hawaii Ends Universal Child Health Care 7 Months After Start
Saturday , October 18, 2008
HONOLULU — Hawaii is dropping the only state universal child health care program in the country just seven months after it launched.
Gov. Linda Lingle’s administration cited budget shortfalls and other available health care options for eliminating funding for the program. A state official said families were dropping private coverage so their children would be eligible for the subsidized plan.
"People who were already able to afford health care began to stop paying for it so they could get it for free," said Dr. Kenny Fink, the administrator for Med-QUEST at the Department of Human Services. "I don’t believe that was the intent of the program." …
Hawaii lawmakers approved the health plan in 2007 as a way to ensure every child can get basic medical help. The Keiki (child) Care program aimed to cover every child from birth to 18 years old who didn’t already have health insurance..
State health officials argued that most of the children enrolled in the universal child care program previously had private health insurance, indicating that it was helping those who didn’t need it.
The Republican governor signed Keiki Care into law in 2007, but it and many other government services are facing cuts as the state deals with a projected $900 million general fund shortfall by 2011…
Families with children currently enrolled in the universal system are being encouraged to seek more comprehensive Medicaid coverage, which may be available to children in a family of four earning up to $73,000 annually.
These children also could sign up for the HMSA Children’s Plan, which costs about $55 a month…Despite Hawaii’s experience, the expansion of SCHIP was still rammed through Congress as soon as the Obama administration was sworn in.
Meanwhile Hawaii’s hospitals have losing money for eight years and are going broke.
From the Associated Press:
Hospitals in Hawaii report $150 million in ’07 losses
October 24, 2008
HONOLULU (AP) – Hawaii hospitals suffered operating losses of $150 million last year and expect the situation to worsen in the near future…
Hawaii Medical Center, which operates two former St. Francis hospitals on Oahu, filed for bankruptcy this year and cut the number of beds it offers.
The state’s publicly subsidized hospital network, Hawaii Health Systems Corp., has had to request millions in emergency funding from the state to stay afloat.
Kona Community Hospital, part of the network, laid off 10 percent of its workers. Also on the Big Island, the privately run North Hawaii Community Hospital laid off 12.6 percent of its staff.
A Ernst & Young LLP report released Thursday, and prepared for the Healthcare Association, shows hospitals as a group have sustained operating losses for eight consecutive years.
Reimbursements from Medicare, which represent about one-third of Hawaii patient charges, only covered 77 percent of costs. Medicaid/ Quest payments covered about 71 percent of costs.
Payments from private insurers such as the Hawaii Medical Service Association cover slightly more than expenses, but they are not enough to make up for losses produced in providing medical services to Medicare and Medicaid/Quest patients…
And, on top of everything else, it turns out that Hawaii’s wonderful employer mandated health-care isn’t working out so well, after all.
Strangely enough, businesses have found ways to get around it. Such as hiring fewer than 20 employees.
From the Honolulu Advertiser:
Isle health care law questioned
Tuesday, June 30, 2009
A law enacted in Hawai’i in 1974 that requires employers to provide health insurance for employees working at least 20 hours a week is being cited by researchers who are skeptical of similar mandates being suggested in the argument for universal health care.
The result of Hawai’i’s Prepaid Health Care Act has been that businesses have relied more on employees who work fewer than 20 hours a week and thus aren’t covered under the requirement, wrote San Francisco Federal Reserve Bank research adviser Rob Valletta and co-authors Tom Buchmueller and John DiNardo, both University of Michigan professors.
The results of the research into health insurance coverage in Hawai’i "imply that an employer mandate is not an effective means for achieving universal coverage," they wrote.
"Although overall insurance coverage rates are unusually high in Hawai’i, a substantial number of people remain uninsured, suggesting a need for alternative approaches if universal coverage is the ultimate goal," they said…So the solution is obvious – stricter mandates from the Federal Government.
By the way, the Heritage Foundation had challenged the idea of using Hawaii as a model for any national system back in 1994.
Here is the conclusions of one of their reports at the time:
A Critique of the Hawaii Health Care System
by Hellreich, Phillip D., Dr.
Heritage Lecture #496
August 4, 1994
… In conclusion, Hawaii has had most of the components of the Clinton health care proposals in effect since the enactment of its Prepaid Health Care Act in 1974.
It has failed in its two major goals of 1) decreasing the number of Hawaii’s population that were uninsured and 2) curtailing the ever-rising costs of health care delivery.
In order to control spiraling health care costs, it has just instituted its Health Quest Program, which will severely ration care and deprive most of the citizens of our state of their right to be treated by the physician of their choice. In light of this information, the American people and members of Congress should think long and hard before enacting a health care proposal which shares so many features of Hawaii’s Prepaid Health Care Act.
Isn’t it odd how we no longer hear about Hawaii being the model for a US system of healthcare?
Probably because it turned out to show us all too clearly where we will be headed under its favorite son’s ‘Obama-Care,’ after all.
