Dreaming of a move to tropical Hawaii? If you’re serious about your dream, go beyond visions of a beach at sunset. Consider how public health and the rollout of the Affordable Care Act may affect your quality of life.
This brief summary of overall health and health care reform provides useful information for current residents as well as those who may join them in the future.
Hawaii health ratings
Hawaii is among the healthiest states in the nation according to the Scorecard on State Health System Performance 2014. The Aloha State is ranked No. 5, down from its No. 2 ranking in 2009. See Hawaii’s Scorecard to see how its performance on individual health measures contributed to its overall high score.
Hawaii tops America’s Health Rankings from 2013, the most recent evaluation available from this organization. Hawaii was also ranked No. 1 in 2012. Hawaii earns its high ranking for low smoking and obesity rates, high immunization rates among children, and a low rate of preventable hospitalizations. Hawaii does have some public health challenges, including a high prevalence of binge drinking and a low high school graduation rate.
Two other resources provide helpful information about public health in Hawaii. The Trust for America’s Health examines key health indictors, public health preparedness, and funding indicators. See Key Health Data About Hawaii. If you want to learn about a specific area of the state, get county-by-county health rankings for Hawaii from The Robert Wood Johnson Foundation and the Population Health Institute at the University of Wisconsin.
Hawaii and the Affordable Care Act
Hawaii embraced the Affordable Care Act, acting to implement a state-run health insurance marketplace and expand Medicaid.
Both of Hawaii’s U.S. senators and its lone representative voted “yes” on the Affordable Care Act in 2010. Hawaii was one of the first states to authorize a state-run marketplace, with Gov. Neil Abercrombie signing a bill into law in July 2011.
Despite the state’s early legislative action on a state-run marketplace, the Hawaii Health Connector operated poorly throughout the 2014 open enrollment period and now faces financial difficulties.
How did the ACA help Hawaii?
According to the Gallup-Healthways Well-Being Index, Hawaii’s uninsured rate dropped just 0.2 percentage points between 2013 and mid-2014. However, consider where it started: Hawaii had the nation’s second lowest uninsured rate – 7.1 percent – prior to 2014 ACA open enrollment. Post-enrollment, it remains at the No. 2 spot with its current 6.9 percent uninsured rate. In both measurement periods, Hawaii is second to Massachusetts – the state that served as the model for the Affordable Care Act.
Hawaii has long supported broad access to medical insurance. The state’s historically low uninsured rate is largely the result of the Hawaii Prepaid Health Care Act, which was enacted in 1974 and requires most employers to provide health insurance to employees who work more than 20 hours a week. The Hawaii Prepaid Health Care Act has much stronger requirements for employer-provided coverage than the ACA. Some in Hawaii fear that a move to the federal exchange, which is a possible fix for Hawaii Health Connector’s operational and financial problems, would be a step backward.
Hawaii enrollment in QHPs
Due to both technical problems and a small market, just 8,592 Hawaiians signed up for qualified health plans (QHPs) during 2014 open enrollment. As a percentage of the estimated market, that’s just 14.9 percent – one of the lowest rates in the nation and about half the national average.
Hawaii was among the 27 states and the District of Columbia that implemented Medicaid expansion. Kaiser estimates that 74 percent of the 102,000 uninsured, nonelderly Hawaiians will qualify for financial assistance under the Affordable Care Act. About 58,000 of the uninsured will qualify for Medicaid or the Children’s Health Insurance Program (CHIP).
Read the Medicaid FAQs on the state’s MyBenefits site to learn about Hawaii’s Medicaid program.
Other reform provisions in Hawaii
The ACA’s Consumer Operated and Oriented Plan (CO-OP) Program offered loans for the creation of nonprofit insurers as a strategy to increase competition in the individual and small-group markets. During 2014, 23 CO-OPs were operational. However, none were in Hawaii.
State-level health reform in Hawaii
Here’s what’s happening in Hawaii at the state level with healthcare reform: