Task force working to make Hawaii first state to insure all

The governor’s panel is tasked with creating coverage for the 1 in 10 uninsured residents

KAILUA-KONA » A health care task force is working on a number of plans to provide health care for the 10 percent of Hawaii residents who are not covered by insurance.

Among the topics under discussion is a network of community health centers and a health authority to oversee all insurance plans.

"It's a very complex area, and we don't want to simply adopt a plan that would have negative impacts," said state Insurance Commissioner J.P. Schmidt, a member of the task force. "One main challenge has been to focus down on manageable issues that hopefully we can have a positive impact on."

About 112,000 Hawaii residents are not covered by health insurance. Roughly 40,000 might be eligible for a government-sponsored program but are not using it.

The 13-member Hawaii Health Care Task Force is made up of lawmakers, health care professionals and health insurance executives appointed by the governor, and is affiliated with the Hawaii Uninsured Project. It was created by the Legislature earlier this year with a mandate to develop a plan for implementing health care for all Hawaii residents. The group began meeting in August and will continue through June.

One idea is to create a network of community health centers across each of the islands, said task force member Rep. Josh Green (D, Keauhou-Honokohau). There are already 13 such health centers, which provide preventive and primary care services and charge patients according to income.

Green said he is optimistic the plan will get the approval of state lawmakers at next year's legislative session, and enrollment could start within a year.

Medical care will be offered on a sliding scale, topping out at $30, he said.

Insurance also will be offered for less than $100 a month, Green said, which will cover stays at state hospitals, tests and some basic prescription drug costs.

"It won't be fancy but it will be quality," he said. "We already have a system in place. It's going to morph a little bit, I'm sure, but the core is there. The main goal is to get primary care to those without insurance."

Green said federal and state funds would help pay for the program. State hospitals receive $650,000 in federal funds, and the state has $3 million to help cover uninsured patients.

Green, a doctor who frequently works at the Pahala and Kohala emergency centers on the Big Island, said part of the problem is a lack of affordable health care for those with minor or chronic ailments that become serious if not treated.

For example, he said, a common kidney infection can be treated with antibiotics, but untreated it can lead to a hospital stay and even kidney failure, requiring dialysis. Instead of a $30 visit to a community health center, costs could escalate to $1,000 a day for a hospital stay and even require long-term dialysis treatment, Green said.

For those who cannot afford such treatment, the state uninsured fund kicks in and is drained quickly each year. From 1998 to 2003, such cases cost more than $500 million.

Schmidt said another plan under consideration would create a health authority to bring all health care coverage under one umbrella. In addition to ensuring coverage for everyone, the authority would centralize insurance programs.

The task force is considering hiring a consultant to evaluate the costs of converting to the so-called single-payer system. If the task force is successful in getting affordable insurance and quality health care to each resident, Hawaii would be first state to make that claim.