Too many Hawaii residents lack health insurance

THE ISSUE A task force is examining proposals to provide health insurance for the 10 percent of Hawaii residents who are uninsured.

DESPITE being the only state requiring companies to provide health insurance to employees, the percentage of Hawaii residents outside the safety net has been rising. A state task force is examining ways to cover more people who are exempt from the system or unaware that they are eligible for government coverage. Legislators and the Lingle administration should find common ground to address the problem.

Soon after the enactment of the health-insurance law in 1974, only 2 percent of Hawaii's residents were left uninsured. That rose to 4 percent in the 1980s and now is estimated at 10 percent, amounting to about 112,000 people. It remains below the national average but is more than the uninsured percentage in four states that have expanded health-care programs for the poor.

Part of the reason for the rise is that some companies have chosen to hire part-time employees so they can be exempt from the law. Coverage is not required for employees who work fewer than 20 hours a week, which is a major reason many people have to work at two or more part-time jobs.

However, part-timers and sole proprietors account for less than one-sixth of the uninsured. According to the Census Bureau, an average of 31,376 of the 84,369 uninsured Hawaii adults over the past decade had full-time jobs. The state clearly needs to be more robust in monitoring and enforcing the law.

The federal data also showed that more than 25,000 of Hawaii's children were uninsured, including 19,548 children from low-income families who were eligible for free government health insurance coverage. The state Department of Human Services and the nonprofit Hawaii Covering Kids responded last year with an outreach effort that resulted in the signing up of 8,449 children.

Rep. Josh Green, a Big Island doctor and member of the Hawaii Health Care Task Force, proposes expanding community health centers to provide preventive and primary care, with fees on a sliding scale according to income. Lingle also has called for more funding of community health centers.

The task force began meeting in August and is scheduled to complete its work in June, but that should not keep the Legislature from taking some action in its next session. Nor should it prevent the Department of Education from requiring students to provide proof of health insurance so it can identify children who might qualify for government insurance coverage.

The Hawaii Uninsured Project, initiated five years ago by the HMSA Foundation, developed a number of strategies earlier this year to expand coverage to lower income families. They are targeted at coverage of families making up to three times Hawaii's federal poverty level, which is $11,010 for a single person and $3,750 for each additional family member.