Report Title:
Healthcare; Universal
Description:
Establishes agency to operate a single-payer universal healthcare insurance system.
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THE SENATE |
S.B. NO. |
3210 |
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TWENTY-THIRD LEGISLATURE, 2006 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
RELATING TO HEALTHCARE.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. The legislature finds that it is in the best interest of the State of Hawaii for each and every state citizen to have publicly provided high quality and affordable healthcare insurance coverage. Healthcare is more than just medical insurance payouts. It includes cost-saving preventive and early intervention measures to prohibit medical conditions from becoming chronic, permanently disabling, or fatal.
Hawaii's current healthcare insurance complex is a disjointed, costly, inefficient, and unnecessarily complicated multi-payer private medical insurance model that is mostly profit-driven, adversarial, beset with constant cost-shifting and reluctant healthcare delivery, onerously bureaucratic, and generally economically irrational. Additionally, healthcare rates are skyrocketing at or near double-digit annual rates and are creating an affordability and accessibility crisis for Hawaii's residents.
The three biggest cost-drivers of healthcare in the United States and Hawaii today are associated with the following:
(1) A profit-driven complex of payment-reluctant multi-payer health insurance bureaucracies competing to insure only the healthy and the wealthy, while leaving those who need healthcare the most to the taxpayers;
(2) The lack of a central electronic healthcare database; and
(3) High cost prescription drugs.
For more than a quarter of a century, Hawaii was far ahead of most other states and often called itself "the health state" because of the 1974 Prepaid Healthcare Act. Hawaii was once known for having a low uninsured population of between two and five per cent in 1994. But, the crisis in healthcare on the United States continent began coming to Hawaii.
Today, more than one hundred thousand Hawaii citizens are without any healthcare insurance coverage. More than twelve thousand of the uninsured are children. Many other Hawaii residents are underinsured, unable to really use their insurance properly or even at all, because of increasingly expensive deductibles and out-of-pocket co-payments for outpatient visits, diagnostic tests, and prescription drugs, among other factors
The annual high increase in premium costs translates into increased employer costs. Under the prepaid health care act, private-sector employers are required to pay at least one-half of health insurance premiums for employees that work twenty hours or more per week. Public employers generally pay even more because of their exemption from the prepaid health care act and must negotiate with their employees for employer-provided family healthcare insurance.
The prepaid health care act does not require employers to provide health insurance coverage for employees working less than twenty hours per week. Increasing health insurance costs has led to several employers hiring individuals to work only part-time, or less than twenty hours per week, to avoid having to pay for employee healthcare benefits under the prepaid health care act.
Even well-insured individuals are experiencing problems with their health maintenance organizations and insurance companies denying, or very reluctantly dispensing, expensive medicines and treatments. About half of all bankruptcies are due to extremely expensive catastrophic illnesses that are not covered after a certain cap is reached. Other persons are near bankruptcies with their quality of life seriously impacted.
The legislature further finds that Canada has for many years had a tried, tested, and true universal publicly administered healthcare-for-all healthcare insurance model with one payout agency for caregivers and providers. A variation of this very successful system adapted to meet the unique conditions in Hawaii would be very beneficial for the following reasons:
(1) For union members and their employers, it means taking healthcare off the negotiating table;
(2) For patients, as taxpayers and insurance premium-payers, it means significant reductions in overall costs, increases in benefits, and the slowing of annual inflation cost increases. It also means a comeback from increasingly uncaring profit-driven healthcare to the restoration of human-need driven mutually respectful and caring patient-doctor-nurse-and other caregiver relationships, which in earlier times were fundamental to meaningful health care;
(3) For businesses, large and small, it reduces significant overhead expenses;
(4) For the local economy, it means keeping almost all healthcare dollars in the State;
(5) For government, it means having one integrated electronic health information database for unprecedented planning and cost-containment capabilities. It also means relief from the perceived emerging problem of "unfunded liabilities" associated with long-term funding of government retiree lifetime healthcare benefits;
(6) For physicians, nurses, and other caregivers, it means less paperwork, much less work stress, and much more time with patients;
(7) For hospitals, community health clinics, homecare providers, and long-term care facilities, it means sufficient and dependable annual financing through global budgets; and
(8) For the general public, it means accessible and affordable healthcare for every person, and relief from the increasing stresses of constant worries over healthcare coverage instability.
The purpose of this Act is to create a unified, single-payer, universal healthcare system covering all Hawaii residents, similar to that of Canada's.
SECTION 2. The Hawaii Revised Statutes is amended by adding a new chapter to be appropriately designated and to read as follows:
"Chapter
SINGLE-PAYER UNIVERSAL HEALTHCARE SYSTEM
§ -1 Single-payer universal healthcare insurance system; established. (a) There is established the single-payer universal healthcare insurance system to provide the same high-quality level of "medically necessary" healthcare to all Hawaii citizens. Private healthcare insurers are prohibited from duplicating the coverages provided by the single-payer universal healthcare insurance system.
§ -2 State healthcare insurance planning and financing authority. (a) There is established within the department of taxation, for administrative support purposes, the autonomous state healthcare insurance planning and financing authority, to determine the costs of the system, and to gather together the needed financing methods and transition mechanisms.
(b) Effective July 1, 2008, the functions of the state health planning and development agency are transferred to the state healthcare insurance planning and financing authority, as well as the prepaid health care act functions and the Hawaii employer union health benefits trust fund, and these functions will be maintained until the full integration of each into the system can be completed by the state healthcare insurance planning and financing authority.
(c) Directors of the authority shall be chosen through statewide election, be composed of seven voting members, and meet the same age and residency requirements as candidates for the state senate. There shall be one executive director member elected with no requirement. All members shall be elected by voters statewide for terms of six years each, except that the terms of the six non-executive director members in the first election shall be for two, four, and six years, respectively, with each seat's initial term of two, four, or six years being determined by lottery conducted by the office of elections. Three of the non-executive directors shall be residents of the city and county of Honolulu. Of the other three, one each, shall be a permanent resident of Hawaii county, Kauai county, and Maui county, respectively.
(d) The state healthcare insurance planning and financing authority shall:
(1) Start up and maintain a trust fund comprised of a pay-as-we-go transfer payments system and a reserve fund;
(2) Negotiate and receive all federal, state, and other appropriate healthcare revenue;
(3) Assess temporary progressive income and general excise surtaxes for start-up, for emergency costs as necessary, for instance, during epidemic or other medical catastrophe;
(4) Be the single-payer of universal healthcare financing (the one payout agency) for Hawaii;
(5) Hire a chief executive officer who will be accountable for the development and success of the single-payer universal healthcare system; and
(6) Conduct a continuous and ongoing program of enrollment.
(b) The concurrence of a majority of all members shall be necessary to make any action of the authority valid.
(d) The salary of the executive director shall be $ a year and the salaries of the other members shall be $ a year."
SECTION 3. This Act shall take effect on July 1, 2006.
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INTRODUCED BY: |
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