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Medical project
seeks to close
uninsured gap

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By Helen Altonn
Star-Bulletin

WHEN Hawaii was declaring itself a health state 10 years ago, Beth Giesting said, "I felt it was such a shame because we were so close to closing the gap, but we were ready to declare victory and not see we still had a gap."

An estimated 7 percent to 10 percent of island residents now fall into the widening gap, and about 200 community leaders have joined forces to try and erase that blot from the state's health picture.

"That is a lot of people, and we certainly shouldn't minimize that we have over 100,000 people uninsured," said Giesting, executive director of the Hawaii State Primary Care Association and member of the steering committee for the Hawaii Uninsured Project.

"Hawaii is such a small place; we really can close the gap. We really can take care of the problems of everybody who doesn't quite fit into the system."

Government and private business and agency leaders convened Tuesday in what was billed as the "leadership assembly" for the Uninsured Project.

A report summarizing the discussions and recommendations was distributed Thursday by the Hawaii Medical Services Association Foundation, which is sponsoring the project.

The fast work in getting out a report shows it is an action-oriented group, said Virginia Pressler, state Health Department deputy director for health resources administration. "I don't think it will sit on a shelf."

Both Giesting and Pressler, also a steering committee member, said they were impressed with the number of people who stayed throughout the daylong meetings.

"It seemed that people were interested in the problem and wanted to solve the problem, which is not something we've always heard in the past," Giesting said.

Pressler said she was impressed with a presentation by Vickie Gates, vice president of the Academy for Health Services Research and Health Policy in Washington, D.C.

Gates told the group Hawaii has a unique situation and can make a significant impact on the uninsured problem because of its two major medical insurance carriers and state-private collaboration.

Access to medical care was highlighted as a special problem, particularly on the neighbor islands, Pressler noted.

"It could be that they don't have willing providers, or no transportation or can't get away from work," she said. "So many things are interfering with people taking advantage of health benefits available to them.

"It's in the interest of everyone if we can get them in the system early on, to get the primary care they need, so they don't end up in ER with kidney failure or the end stage of a chronic disease," Pressler added.

The leadership assembly was the first step to begin gathering information from those in the health care field so they can come up with solutions, said Cliff Cisco, HMSA vice president, who is also on the project committee.

"There are many stories why people are uninsured, so no one solution will work," he said. "We're going to have to find many solutions."

The big question is who are the medically uninsured and how many are there at any time, the participants said, emphasizing the need for more data.

Recommendations were presented from government, private insurance, safety net and Prepaid Health Care Act perspectives.

Hawaii is the only state to have a mandate for health insurance for certain employers, and the law "has served Hawaii well," conference participants said.

However, critics say the law creates a hardship for small businesses and no longer provides enough coverage for employees.

Because of a coverage threshold of 20 hours per week, many businesses have "regular" employees who receive health care and another group of part-time workers who are not covered.

Many other so-called "middle-class" jobs are handled on a contract basis where employees must obtain their own insurance, participants pointed out.

They recommend eliminating the state government's exemption from the act, giving employers a premium subsidy or tax credit for part-timers, and allocating insurance costs between employers when there are multiple employers.

Cisco said pooled purchasing, coordinated between the state and community, might work here to cover individual entrepreneurs and others who fall through the cracks.