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HMSA launches
drive to avert
state health crisis

The foundation will unite
isle agencies in helping the
growing number of people
who lack health coverage

Coverage eludes many

By Helen Altonn
Star-Bulletin

The HMSA Foundation announced today it is making a $300,000, three-year commitment to reduce the state's rising rate of medically uninsured residents.

Cliff Cisco, Hawaii Medical Service Association senior vice president, said the foundation will bring together concerned public and private agencies "so we can act as one voice on different issues on the uninsured."

Among the issues to be examined -- defining how many people really are uninsured, and why, Cisco said. Figures ranging from 7 percent to 13 percent have been cited by different agencies. HMSA uses the 7 percent figure and estimates about 31,000 of the uninsured are children -- 40 percent, compared with a national average of 25 percent for communities of similar size.

The foundation will organize statewide conferences of community leaders, starting this summer, to brainstorm and possibly identify some policy issues for legislators, Cisco said.

"There is no single reason why we're having a growing number of uninsured," Cisco said. "But all these things come together."

Hawaii's hospitals are losing $195 million a year in uncompensated care, and eight statewide community health centers last year lost $1.16 million caring for the uninsured.

Beth Giesting, Hawaii State Primary Care Association executive director, said the health centers "are at the end of their financial limits" in caring for nonpaying patients. Uninsured numbers at the health centers increased 55 percent between 1997 and 1999, she said.

The state House budget includes $800,000 for the health centers to care for the uninsured. Giesting said she hopes the Legislature also will fund some dental services for adults.

"One of the problems we have in Hawaii when we call ourselves 'The Health State' is we conveniently forget about those people who don't have insurance," Giesting added. "We just sweep them under the carpet because it (the uninsured) is a relatively minor problem.

"But we come in last in the nation in dental and mental health standards."

However, Dr. Virginia Pressler, Health Department deputy director, said Hawaii is held out as national model for the low number of uninsured. "I don't know if we're the best, but we can do better."

"If we can get health coverage for everybody in the state and get them to use coverage," Pressler said, "we can decrease health costs and be more proactive."

Kate Stanley, state Human Services Department deputy director, said Hawaii possibly could push its medically uninsured rate to zero if the federal government would reconsider its position prohibiting federal Medicaid funds for immigrants and migrants.

The governor's office and its partners in working to get all eligible children enrolled in health insurance in "Boost 4 Kids" are pleased that HMSA is attempting to pull together the "patchwork array" of programs, said Lynn Fallin, special assistant to the governor. "No one entity can do it themselves."

Richard Meiers, Healthcare Association of Hawaii president and chief executive officer, said he's excited about the proposed community effort if there is follow-through. Good ideas and plans were made by other groups over the years, but "things never moved on," he said.

Giesting said she's delighted HMSA is taking a lead to try to solve the problems, but as long as there isn't a national program covering everyone, "we will always have a 'gap group.' "

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Medical insurance eludes many Among reasons cited by state and community leaders for Hawaii's medically uninsured population: Employers are required to provide health plans for employees under the state's prepaid health plan act, but many may have reduced coverage because of the state's ailing economy or are hiring part-time workers to avoid paying health benefits. The law doesn't require employers to cover dependents, so children may be omitted. Parents may not be able to afford medical insurance for their children, or choose not to cover them. Immigrants are ineligible for Medicaid for five years under federal law. The state is providing $590,000 annually in its Medicaid budget to the community centers to help provide immigrant health care, but it doesn't meet all the needs. The U.S. Health and Human Services Department has said that federal funds no longer can be used for Medicaid for residents of the Association of Free Compact States (the Federated States of Micronesia, the Marshall Islands and the Republic of Palau). The decision affects about 2,600 people in Hawaii. Helen Altonn, Star-Bulletin