September 9, 2024

Written by Contributor Stephen Kemble, Healthcare for All Hawaii, Hawaii Health Authority; Board Member PNHP

State-based SP organizations:

Healthcare for All Hawaii: https://www.facebook.com/groups/healthcareforallhawaii/

PNHP chapter: https://pnhp.org/chapter/hawaii/

National Affiliations: PNHP

PNHP: http://www.pnhp.org

State-based SP bills:

The Democratic Party of Hawaii used to have a Health Committee supportive of single-payer, but the newly elected chair of the party disbanded the Health Committee in 2021. That Democratic Party of Hawaii chair resigned in 2023, and we don’t yet know the attitude of the new leadership toward single-payer. Hawaii’s governor, Dr. Josh Green, is not interested in pursuing single-payer and seems to have allied himself with the dominant insurance companies.

Advantages for SP in current context:

Hawaii health systems closer to single payer since 1970s. According to Kemble, a geographically isolated state such as Hawaii may have a shot at implementing a state-based health care system that can achieve substantial administrative savings by capturing all health care funding streams controlled or regulated by the state and requiring them to standardize their health insurance “product.” This would include state and county employees and retirees, Medicaid, and commercial plans falling under our Prepaid Health Care Act. There is only one widespread Medicare Advantage plan there, run by HMSA, and if it could be included in the standardization, we could capture about 90% of all non-Kaiser health insurance in a Hawaii all-payer system, enough to achieve substantial administrative savings all around.

Hawaii already partially achieved a functioning all-payer system with the Prepaid Health Care Act, in place since 1974, which includes an ERISA exemption allowing Hawaii to impose an employer mandate requiring provision of health insurance to all employees working 20 hours a week or more, with standardized comprehensive benefits, no deductibles, and either 10% or 20% co-pays. Prior to the Affordable Care Act, Hawaii had the broadest coverage of our population in the country, the best benefit package, the lowest patient cost-sharing for employer based insurance, and the third lowest commercial health insurance premiums in the country. We have two dominant insurers and one is Kaiser, with their own separate system. The other, HMSA, with over 90% of the non-Kaiser market, used to pride themselves on having the lowest administrative cost of any health insurance company in the country, at 8% prior to the ACA.

In 2009, Hawaii passed a bill into law, HRS 322H, creating the Hawaii Health Authority (HHA), charged with overall health policy for Hawaii and with designing a universal health care system covering all residents of Hawaii. However, none of the past three Democratic administrations has chosen to implement the law and empower the HHA to fulfill its statutory mission.

Rep. Jill Tokuda is a solid supporter or S-P (co-sponsored HR 3421, Jayapal bill).

Rep. Ed Case is skeptical of single-payer.

Senators Hirono and Schatz are both co-sponsors of S 1655, Sanders bill.

Obstacles to SP in the current context

Entrenched insurance company opposition, and their ability to buy the votes of legislators.

Not enough elected legislators supporting single-payer or all-payer bills when we last introduced them in 2020.

Unfortunately, since ACA reforms, administrative costs have skyrocketed, commercial health insurance premiums have doubled, and doctors are being rapidly forced out of independent practice, leaving us 25% short of the doctors we need, and as high as 44% short on the more rural outer islands.

Goals for SP movement in HI 2024-2025

Building grass roots awareness of features of and need for single-payer.

Working to persuade more legislators of the need for single-payer.

Build up Healthcare for All Hawaii Facebook page.

Where can people find news about Single Payer in your state and/or join a group?

https://www.facebook.com/groups/healthcareforallhawaii/