1. * 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 05/2003 Sponsor: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

2. * Hawai'i Coverage for All Project * DHHS / HRSA State Planning Grant * RCUH Prog. # 659075 * Envisioning Health Coverage Based On : Interviewees’ self-identified health coverage needs and perceptions. Interviewees talk story about the health care system in Hawai’i.

3. * 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?

4. * Hawai'i Coverage for All Project * DHHS / HRSA State Planning Grant * RCUH Prog. # 659075 * Health Coverage Ideals Affordable Accessible Equitable Flexible Understandable Uninterrupted Worthwhile

5. * 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

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

7. * 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

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

9. * 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”

10. * 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

11. * 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;

12. * 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.

13. * 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.

14. * 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.