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
Health Committee of Democratic Party of Hawaii (See good goals in 2018 Platform, Don’t see a standing Health Committee
State-based SP bills
In 2020 session, HB2018 https://www.capitol.hawaii.gov/session2020/bills/HB2108_.HTM
The Democratic Party of Hawaii Health Committee submitted legislation for the 2020 session to empower the Hawaii Health Authority to establish a state-based all-payer system that would avoid many of the federal obstacles to state-based single-payer reform, but which would achieve most of the administrative savings of a true single-payer system by requiring all payers to offer a standardized insurance “product,” with the same benefits, same network of all qualified providers, same payment system and fees for all payers, and same formulary and prior authorization policies.
Status: The bill is in committee, (but there do not appear to be enough legislators on board to pass it).
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, neither of the past two Democratic administrations has chosen to implement the law and empower the HHA to fulfill its statutory mission.
Tulsi Gabbard is a solid supporter or S-P (co-sponsored H1384, Jayapal bill)
Senators Hirono and Schatz are co-sponsors of S 1129, 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 HB2018 to implement it.
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 CA 2019-2020
Building grass roots awareness of features of and need for single-payer,
Working to persuade more legislators of the need for single-payer (or the highly regulated form of “multi-payer” system described in HB2018).
Build up Healthcare for All Hawaii Facebook page.
We need more work on Sen. Brian Schatz, Sen. Mazie Hirono, and Rep. Ed Case. None of these have shown hard opposition for state-based legislation, and all are willing to listen and open to education, but not yet convinced. Case not a co-sponsor of H1384.
Where can people find news about Single Payer in your state and/or join a group?