* Hawai'i Coverage for All Project * DHHS / HRSA State Planning Grant * RCUH Prog. # 659075 *

“Coverage is Confidence”

The Uninsured

Envision Health Insurance For Hawai'i

Heather Young Leslie Ph.D.

Carol Murry Ph.D.

William D. Wood Ph.D.

Hawai’i Coverage For All Project Presentation 05/2003Sponsor: US DHHS, HRSA State Planning Grant

Contractor: Hawai’i State Dept. of Health.

Contract No: P09 0A 00046-01

Subcontractor:: Research Corporation, University of Hawai’i (RCUH), Social Sciences Research Institute (SSRI).

Subcontract No: RCUH Program No 659075

* Hawai'i Coverage for All Project * DHHS / HRSA State Planning Grant * RCUH Prog. # 659075 *

Envisioning Health CoverageBased On:

  Interviewees’ self-identified health coverage needs and perceptions.

Interviewees talk story about the health care system in Hawai’i.

* Hawai'i Coverage for All Project * DHHS / HRSA State Planning Grant * RCUH Prog. # 659075 *

Research Questions:

What does having health coverage mean for you?

Should health coverage be for everyone?

What problems have you had with health coverage?

What suggestions can you make about improving health coverage access in the state of Hawai’i?

What would your dream coverage be?

* Hawai'i Coverage for All Project * DHHS / HRSA State Planning Grant * RCUH Prog. # 659075 *

Health Coverage Ideals

 Affordable

Accessible

Equitable

Flexible

Understandable

Uninterrupted

Worthwhile

* Hawai'i Coverage for All Project * DHHS / HRSA State Planning Grant * RCUH Prog. # 659075 *

Affordability is a Key Issue

Descriptions of affordability ranged widely.

What is interesting is that in most cases, the specific premium hypothesized echoed other basic utility bills, such as telephone, electricity, cable, car insurance, storage locker, even a gym membership.

Making it affordable:

Premiums geared to income & family size

Medical debt amnesty and/or debt restructuring assistance

* Hawai'i Coverage for All Project * DHHS / HRSA State Planning Grant * RCUH Prog. # 659075 *

AccessibilityIssues:

Alienating bureaucracy (forms, rules & workers)

Lack of knowledge re: system, rules,options, actual coverage

Language (foreign & bureaucratese)

Mailing Address / homeless

Rural locales & limited services,

Transportation

Staff sensitivity training

Multilingual Orientation & Information Campaign

Multilingual Services

Community-based workshops

Online forms, in-office assistants & optional pick up locations

‘Smart-cards’ (photo, medical history & coverage plan).

More care vans, mobile clinics, community health centres.

Mental health & addictions counselling in rural areas.

* Hawai'i Coverage for All Project * DHHS / HRSA State Planning Grant * RCUH Prog. # 659075 *

Equitable

Issues of respect

Strong support for equal care regardless of premiums paid

Quality Basic Coverage includes:

Emergency & catastrophic coverage

no lifetime cutoffs

Public health, mental health & preventative medicine

Dental (Not just extractions)

Drugs (including harm-reduction, prophylactic)

Vision

* Hawai'i Coverage for All Project * DHHS / HRSA State Planning Grant * RCUH Prog. # 659075 *

FlexiblePeople Suggested:

Pay via income taxes

Geared to income, payments based on previous quarter

Long-term, no-interest payment options for large debts.

Self-tailored options:

chiropractic, massage, naturopathy, homeopathic, lomilomi, etc.

* Hawai'i Coverage for All Project * DHHS / HRSA State Planning Grant * RCUH Prog. # 659075 *

Understandable Current patchwork of plans, providers, gap-

programs, intra-state rules & forms is confusing

for all involved

Who to ask?

Prior Experiences Frame Misperceptions

Medical Debt Shocks

“Ostriching”

* Hawai'i Coverage for All Project * DHHS / HRSA State Planning Grant * RCUH Prog. # 659075 *

Understandable: How?

Proactive, multi-targeted information dissemination by Providers, Employers, Department of Health

Use churches, jails, schools & local community groups (ie: kava clubs, women’s auxiliary, sports teams) to expand existent word-of-mouth networks.

Workshops targeting those who tend to fall through the gaps: prisoners, youth (19-25 yrs), newcomers, non-English speakers

Information Campaign Providers to post fees for health services & descriptions of plans

in ER, clinic waiting rooms

* Hawai'i Coverage for All Project * DHHS / HRSA State Planning Grant * RCUH Prog. # 659075 *

Understandable: How?

Providers / Employers to format simpler & more easily retained documentation (such as 5x7 fridge magnets), with basic health plan info.

Multilingual, One-stop Information & Coordination Centre

Health Coverage Info Query Hotline; Health Coverage Ombudsman; Insurance Commissioners office to better track &

explain available plans & disseminate information;

* Hawai'i Coverage for All Project * DHHS / HRSA State Planning Grant * RCUH Prog. # 659075 *

“Uninterrupted”

Life Crises

Retirement

Age 19 cut-offs

Self-Employed

Jail

Pregnancy

Unemployment

Monthly Assessments

Family Coverage

How to ensure continuity?Insurers to more appropriately assess premiums for youth, self-employed, sole proprietors

Lower COBRA premiums

Convicts signed on to health plan (Quest?) before release.

Lengthen Quest income & means reporting periods

Newborns automatically covered under mother

Seasonal & casual labor to have family coverage as an automatic option, domestic partners and extended kin (ie parents, siblings) allowable on family plan.

* Hawai'i Coverage for All Project * DHHS / HRSA State Planning Grant * RCUH Prog. # 659075 *

Worthwhile

Feel ‘ripped off’ when coverage unused

To self-fund may seem rational decision

Gambling on wellness

Value of cradle to grave

coverage must be understood to be a long-term, societal benefit

& responsibility.

* Hawai'i Coverage for All Project * DHHS / HRSA State Planning Grant * RCUH Prog. # 659075 *

Coverage is Confidence 

Confidence to send a child on a school trip

Confidence that a parent will be able to walk into a hospital or clinic with dignity

Confidence that the society to which you have contributed will repay that contribution when you

need help

Confidence that when disaster strikes, you will not loose a home, a child’s college tuition,a car, a limb.

Confidence that you will get the same care as anyone else – that wealth and poverty are irrelevant when it

comes to health.