Editorials
Saturday, December 11, 1999

Hospitals’ financial
plight must be faced

The issue: Hawaii's hospitals are losing millions of dollars and some may not survive.
Our view: The weak economy has hurt the industry by reducing the number of people with employer-based health insurance.

FOR decades Hawaii boasted of having the nation's highest percentage of people with health insurance. That was the result of the law requiring employers to pay the bulk of the cost of insurance for their workers. No other state has such a law.

But tying health insurance to employment can have a down side when the economy slumps, as it has here for most of the decade. When people lose their jobs they lose their insurance. Employers struggling to save their businesses resort to hiring part-time workers because they aren't required to provide health insurance coverage.

From a rate of uninsured of 3 to 5 percent, Hawaii has gone to 13 percent of adults and 8 percent of children. This is a disturbing decline in coverage. In addition to leaving a substantial segment of the population without health insurance, it creates a hardship for the hospitals that are forced to provide charity care for the indigent.

Making matters worse for the hospitals is the reduction in federal Medicare and Medicaid payments. As a result, the hospitals are currently losing $195 million a year.

A study commissioned by the Healthcare Association of Hawaii found that the federal government is reimbursing the state Medicare program at a rate 30 percent lower than the national average. This leaves the hospitals in big financial trouble.

Cuts in Medicare and Medicaid were mandated by the 1997 Balanced Budget Act. But the association says the federal Health Care Financing Administration has failed to take into account the cost of living in Hawaii in determining the new level of reimbursement.

Consequently Hawaii has suffered steeper reductions than other states. The association is trying to get that situation corrected.

President Richard Meiers and other health-care association leaders met with the governor and legislators to explain the hospitals' plight. They asked that no new health-care benefits be enacted for the next two years. Under the current difficult circumstances, that request certainly seems justified.

Meiers also urged parents to find out if their children qualify for the state's QUEST insurance program. A few years ago, he said, 13,000 children who were eligible hadn't been enrolled.

The situation is so serious, he said, that some institutions may be forced to close unless relief is granted. Over the next five years, he warned, the hospitals could lose almost $500 million.

There is a chance that federal administrators can be persuaded to increase Hawaii's reimbursements. But an upturn in the state's economy would do wonders by making it possible for more working people to obtain health insurance coverage.

Court had no choice
on same-sex marriage

The issue: The state Supreme Court has ruled against proponents of same-sex marriage.
Our view: The justices had no choice after the voters approved a constitutional amendment on the issue.

IN the wake of the 1998 approval of a constitutional amendment on the issue, the state Supreme Court had no choice but to rule that no right to same-sex marriage exists in Hawaii.

That amendment, approved by the voters by better than a 2-1 ratio, gave state legislators the authority to reserve marriage to heterosexual couples. The result, said the justices, was to make the lawsuit to legalize homosexual marriages moot.

The plaintiffs won a preliminary victory when Circuit Judge Kevin Chang ruled in 1996 that the state's prohibition on same-sex marriages violated the state Constitution's equal protection clause and that the state had failed to demonstrate a compelling need to deny marriage licenses to homosexual couples.

Chang's decision led to the placing of the constitutional amendment on the ballot and an intensely fought battle over the issue, a battle that attracted national attention.

Several states passed laws denying recognition to homosexual marriages and Congress passed a law allowing states to disregard same-sex marriages from other states.

While the Legislature was wrestling with the question, the Star-Bulletin supported same-sex marriage, on the ground that government should remain neutral on the issue of the morality or immorality of homosexual relationships.

The issuance of a marriage license, we felt, should not imply taking a position on the moral aspects of the controversy, which we saw as a matter for individual judgment based on personal religious faith or other values.

We saw no compelling need for the state to deny marriage licenses to same-sex couples, nor do we now.

In our view, placing the constitutional amendment proposal on the ballot was warranted because the people of Hawaii had never been given an opportunity to address the issue of same-sex marriage directly. However, we advocated rejection of the amendment.

The vote on the amendment made it clear that the people of Hawaii were not prepared to accept same-sex marriage. It is possible, of course, that attitudes will change, and we hope they do.

The Supreme Court decision ends the lawsuit, but not the battle. Attorney Dan Foley, who represented the couples who sued the state, predicts further litigation whenever gay or lesbian couples are denied rights or benefits granted to married couples.

The wisest course of action for Hawaii would be to extend full rights and benefits to same-sex couples with the sole exception of marriage.

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John M. Flanagan, Editor & Publisher

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