Why Health Insurance Matters: Health insurance is the key to obtaining needed health care services, and those who lack insurance are less likely to get timely and appropriate care than their insured counterparts. Evidence from the scientific literature overwhelmingly shows that those without insurance--children as well as adults--suffer worse health and die sooner than those who have coverage.1
Addressing Lack of Health Insurance: In 2000, the HMSA Foundation made a three-year commitment to study and address the growing number of people in Hawai'i without health coverage, and The Hawai'i Uninsured Project (HUP) was born. In 2002, federal and national grants awarded to the Department of Health enabled HUP to begin operating in complete independence from HMSA Foundation. A grant from the federal Health Resources and Services Administration (HRSA) funded the Coverage for All in Hawai'i Project,2 a statewide effort to develop and propose viable health care coverage solutions for Hawai'i's uninsured. Selected research results from this project are reported below.
Hawai`i's Uninsured Population: The most recent estimate of the percent of the population without health insurance comes from the federal Current Population Survey (CPS) released in August 2008. These estimates indicate that approximately 96,000 persons, representing 7.5 percent of Hawai'i's population, were uninsured in 2007. Among the 50 states and the District of Columbia, Hawai'i has one of the highest proportions of the population covered by health insurance. Given the consequences of not having health insurance, addressing the needs of the uninsured remains a priority for Hawai'i. Estimates based on the CPS 2005-2007 3-year averages indicate that the uninsured are composed of: 16,600 children (birth to 18 years of age); 86,800 adults (ages 19-64); and 2,400 adults (ages 65 and above). A disproportionate number of uninsured reside on the islands of Hawai'i, Kaua'i, and Maui, rather than on O'ahu, where the majority of the state's population lives. With regard to ethnicity, Japanese and Chinese tend to have the highest coverage rates, while Hawaiians and Caucasians have the lowest.
Target Population: Although Hawai'i's Prepaid Health Care Act (PHCA) mandates that employers provide health insurance coverage for their employees working 20 hours or more per week, a significant number of full-time workers remain uninsured and the number appears to be rising. In addition, those working part-time (less than 20 hours per week) and the self-employed--groups excluded from the mandatory coverage provisions of the PHCA--make up a large proportion of the uninsured population. Together, these groups comprise over 50 percent of the total number of uninsured in Hawai'i.
Financial Impact of Lack of Insurance: Although the Hawai'i resident population is relatively well insured compared to populations in most other states, direct and indirect problems persist. Many low-income Hawai'i residents remain uninsured. Hospitals and community clinics shoulder the burden of providing care for the uninsured with little or no reimbursement, while businesses and individuals are affected with higher insurance premiums. In Hawai'i, the Compact of Free Association allows migrants from Pacific Island compact nations to access Hawai'i's health care system without having either public or private insurance coverage, thus rendering an externally-generated financial burden. Finally, while Hawai'i's unique PHCA requires employer-sponsored insurance for the majority of workers, those who are exempt from the PHCA--part-time public and private sector employees and sole proprietors--struggle to find affordable coverage options.