Child care law called climax of session

Health highlights also include money for Medicaid and underfunded facilities

Free health care will be provided for all uninsured island children under a compromise that was forged by legislators, state officials and other groups to win the governor's approval.

The collaboration resulted in a better "Keiki Care" bill than the one vetoed by Gov. Linda Lingle last year, lawmakers and health advocates said. They hailed the bill as one of the most significant achievements for health this session.

Rep. Josh Green and Sen. David Ige, first-time health committee chairmen, said they felt a lot was accomplished to improve health care in Hawaii.

Besides universal health care for children, Green (D, Keauhou-Honokohau), a Big Island emergency doctor, said major health bills included restoration of rate regulation for health insurers and provision for more local control in the state hospital system administered by the Hawaii Health Systems Corp.

"The biggest thing of all ... from a practical standpoint, we injected $80 million (including state and matching federal funds) into Medicaid," Green said. The money will go toward increased Medicaid reimbursements to hospitals, physicians, outpatient clinics and QUEST programs, he said.

"We had chronic underfunding of health care systems. That is why some hospitals were closing or threatening to close."

Ige (D, Aiea-Pearl City) said the three-year pilot program to ensure that every child has access to health care is the most important achievement this session.

"I'm confident the pilot will show it makes sense to invest in children's health from the very beginning, rather than trying to keep up with health issues later on," he said.

Increased funding also was provided for hospitals that provide charity care, rural community hospitals, doctors who serve Medicaid patients, children with special needs, developmentally disabled and critically mentally ill residents and community-based adult mental health services, Ige said.

In saving Kahuku Hospital from closing with $3.9 million, he noted the Legislature had directed the state Health Department to work with the hospital to look at services that would be economically viable over the long term.

Rich Meiers, Healthcare Association of Hawaii president and chief executive officer, said he is pleased a large share of the state budget is going to health and human services, as the association has been saying for some time that "the health care system is broken."

"The 2007 Legislature was a good beginning to fix some of these problems," he said. "It has to continue in the 2008 Legislature and beyond, until we fix our health care system."

Among legislative actions, $7.5 million in state funds was appropriated to match $10 million in federal dollars this year for hospitals with a disproportionately high number of uninsured patients. Without the state money, the hospitals would lose the federal money and chances of getting more, Meiers said.

Beth Giesting, Hawaii Primary Care Association executive director, called the session's results "a mixed bag" but noted some good things for the community health centers. One was a bill, already signed by the governor, allowing minors to consent to primary medical care, she said.

Another was a controversial bill allowing psychologists to prescribe medicine under limited conditions. It applies only to postdoctoral psychologists with intensive pharmacology training who are working in a community health center with a physician, Giesting said. "A whole lot of safeguards are in there, so we feel we are not endangering the public."

Lillian Koller, director of the state Department of Human Services, which administers Medicaid benefits for 204,000 clients, said, "We asked for and got lots of money to maintain expansions in Medicaid."

The percentage of federal matching money for all Medicaid programs dropped this year and goes down again Oct. 1, so the department had to ask for extra state money to maintain the programs, she said. Federal funding also falls far short of costs of health care for migrants from the Marshall Islands and Federated States of Micronesia, she added.

She said the children's insurance bill "is a fine example of collaboration" by the Department of Human Services, legislators and officials from the Hawaii Primary Care Association and Hawaii Medical Service Association. It includes money to eliminate monthly premium payments for immigrant children, making it free for all children in the Medicaid program up to 300 percent of the poverty level, Koller said.

The department wanted to provide immediate access to coverage, but HMSA, the state's partner for Keiki Care, has a six-month waiting period. The provision will deter families from dropping employer-paid or private coverage -- one of the governor's concerns last year, Koller said.

An infant care program was added to the measure, administered by the Department of Human Services because the HMSA policy covers newborns only at 31 days old, she said.

The Hawaii Medical Association was disappointed that medical insurance reforms were not adopted, but that bill did get further in the House this year, said Executive Director Paula Arcena.

Green said lack of a compromise on medical malpractice reform was his "single letdown," but he feels it can be achieved next year.

While tort reform did not pass, "a baby step" was taken, Meiers said, noting an "apology bill" passed allowing doctors to express regrets without admitting malpractice guilt.