Hawaii Opting Out Of Health Care Overhaul

fromHPR

Hawaii wants out of the national health care overhaul because it already has one of the lowest uninsured rates in the country, thanks to its 35-year-old employer mandate system. Hawaii's congressional delegation inserted language into both House and Senate health care bills that provides explicit protection for the landmark Hawaii Prepaid Health Care Act of 1974. It's apparently the only state looking for such an exemption from major health care overhaul.

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Some people in Hawaii are watching the national health care debate with a been there/done that attitude. Hawaii has one of the country's lowest percentages of uninsured residents and passed its own health care redesign 35 years ago.

From Hawaii Public Radio, Ben Markus reports.

BEN MARKUS: Longtime Hawaii Congressman Neil Abercrombie wants to be clear: Hawaii is not trying to exempt itself from efforts to overhaul health care. But...

Representative NEIL ABERCROMBIE (Democrat, Hawaii): Should the happy circumstance take place that the national bill is better than ours, offers more benefits and is more reasonably priced and available than ours, why, then of course we'll rescind ours.

MARKUS: Hawaii was the first state to attempt universal coverage. It did it by instituting an employer mandate. In other words, all businesses big and small must provide health insurance for employees who work more than 20 hours a week. These days, only about eight percent of Hawaii's population is uninsured. That's half the national average and way ahead of states like Texas with 25 percent uninsured.

Congressman Abercrombie is joined in the fight by the rest of the state's long-term and subsequently powerful delegation. They've inserted explicit language protecting Hawaii's system in both the House and Senate versions of national health care overhaul.

Dr. GINNY PRESSLER (Executive, Hawaii Pacific Health): I certainly wouldn't want to question that wisdom.

MARKUS: That's Ginny Pressler. She's a high-ranking hospital executive and an advocate for Hawaii's uninsured. Pressler has been an influential voice in the Hawaii health care debate for many years. She says there's a lot worth protecting.

Dr. PRESSLER: We do have good health care and access to health care and the lowest cost per enrolling in Medicare anywhere in the nation. And again for our commercial payers, we have the second lowest premiums anywhere in the nation.

MARKUS: Still, Pressler says Hawaii's not immune to the growing cost of health care, a burden that forces some companies to find ways around the mandate.

(Soundbite of health center)

MARKUS: Here at the Waikiki Health Center, it's a busy morning. The center caters to low-income and homeless patients. Through this recession it's seen a tenfold increase in workload as the newly jobless lose their employer provided insurance.

Waiting in line is Jason Samson(ph). He was recently laid off from a local detail shop. To get treatment, he must first sit down with Gari Gorman(ph), an eligibility coordinator. Samson tells her that despite working full time, he didn't get insurance.

Ms. GARI GORMAN (Eligibility Coordinator, Waikiki Health Center): Okay, so they never offered any kind of health insurance at all.

Mr. JASON SAMSON: They told me after 30 days that I would be getting in, but I never got no health card, insurance card, anything like that. And they never took it out of none of my paychecks.

MARKUS: The health center says they see a lot of this - companies withholding insurance against state law. They also hear of employers scaling back hours to avoid the mandate.

Sam Slom is a small businessman and a Republican state senator. He says the mandate has put Hawaii companies who follow the rules at a disadvantage, probably forcing some out of business altogether.

Senator SAM SLOM (Republican, Hawaii): And, you know, anecdotally you can tell stories about that. But somebody says, well, show me. Show me where it actually happened and it's really hard to do.

MARKUS: It's hard to do because the employer mandate as he sees it is just one of many onerous mandates, taxes and regulations in Hawaii.

(Soundbite of restaurant)

MARKUS: Other businesses see the mandate as a benefit. At Murphy's Bar and Grill in downtown Honolulu, owner Don Murphy says he provides health insurance not just for individual employees, but in some cases their whole family.

Mr. DON MURPHY (Owner, Murphy's Bar and Grill): So, you know, you want to help them out. I mean, you know, when you do that, hopefully they stay. And, you know, I've got - god, I don't know - my average employee has probably been here over 10 years. So I've got a couple guys that have been with me since I opened: 22 years.

MARKUS: Though he readily admits the rising cost of that benefit is eating into the bottom line.

Jerry Russo, a health economist at the University of Hawaii, doesn't discount the mandate's impact on businesses. In the face of skyrocketing insurance premiums, he says Hawaii employers are unable to drop coverage.

Professor JERRY RUSSO (Chairman, Economics Department, University of Hawaii): And we've seen that on the U.S. mainland that a lot of employers have dropped coverage. Whereas in Hawaii it's continued to be stable. Now, that may have been a hardship for the employers. We don't really know.

MARKUS: Whether or not the mandate is a hardship on businesses, Russo believes it's quite amazing that a system designed 35 years ago still provides widespread coverage today. And it looks like that system may continue for decades to come - protection for Hawaii's employer mandate is still alive in both the House and Senate versions of health care overhaul.

For NPR News, I'm Ben Markus in Honolulu.

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