Gathering Place

Jacque Smith

Wednesday, September 3, 2003

Complexity of uninsured
needs collaborative remedy

Helen Altonn's story "Health often suffers with lost insurance" (Star-Bulletin, Aug. 21) touches on one facet of a major issue affecting our community -- access to health care.

However, a much larger story needs to be told. Health coverage is one of the hottest topics in the nation and a priority of many presidential candidates vying for the public's favor. Nationally, the uninsured population is 41 million Americans -- the size of Texas, Florida and Massachusetts combined. As the cost for health coverage continues to rise nationally and here in the islands, the number of uninsured is expected to climb. Recently Maine, Vermont and Idaho all have written prescriptions for the expansion of health coverage.

When Hawaii blazed the trail in health coverage reform by establishing the Prepaid Health Care Act in 1974, the only employer mandate of its kind, the nation didn't follow. Hawaii once held the honor of having the fewest uninsured residents of any state, but now it has tumbled down the national ranks (ranked 12) with 120,000 of its people not covered -- that's 10 percent of the state's population.

Can Hawaii once again rise to the challenge of expanding health coverage to its people? The federal government thinks so. It has given the state of Hawaii $1.1 million to address the issue by building a body of research that will profile the uninsured and better inform the community of the issues. The Robert Wood Johnson Foundation, the nation's leading philanthropy that devotes its funding exclusively to health-care issues, thinks so. It has poured $1.3 million in Hawaii's efforts to get the job done through community collaboration and innovative private and public options.

A quantitative analysis to develop a socio-demographic profile of the uninsured is nearing completion. Researchers at the University of Hawaii's Social Science Research Institute also are "getting behind the numbers" with qualitative research that includes statewide one-on-one interviews with the uninsured and providers to uncover the themes, issues and stories of uninsurance in Hawaii. In addition, new studies are being conducted to survey employers, the uninsured and the general public so that their viewpoints and ideas on the issues are heard and understood.

The issues are complex, as are the solutions. As a program of the Hawaii Institute for Public Affairs, The Hawaii Uninsured Project has a broad spectrum of interests and organizations that are forging solutions with the governing goal of expanding access to health coverage.

These probing questions are at the heart of each of the issues we're addressing:

>> Does every child in Hawaii deserve a healthy start?

>> Should someone who holds three part-time jobs be able to purchase affordable health coverage?

>> Is it time to find equitable solutions for the uncompensated care provided by the state and private care providers in Hawaii to the uninsured citizens of Palau, the Federated States of Micronesia and the Marshall Islands?

>> Should categorically eligible adults, the working poor, be allowed access to government-sponsored coverage?

Our biggest challenges require that the people of Hawaii keep an open mind to potential solutions. There's no one magic bullet. The issues are far too complex to be remedied simply, especially since equitable solutions require that neither the private nor the public sector should bear the burden alone.

As our community begins to devise solutions, we must remember that it's not just about solving a problem for the 120,000 uninsured. It's about expanding access to affordable coverage for all of Hawaii's people.

Jacque Smith is associate director of Community Relations & Grant Management for The Hawaii Uninsured Project. Find it online at


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