The Impact of Being Uninsured in Hawaii – 2002-2003 Technical Workshop III Presentation

1. The Impact of Being Uninsured in Hawaii – 2002-2003 Technical Workshop III Presentation D. William Wood, MPH, PhD – Sociology Carol Murry, DrPH, Social Science Research Institute Heather Young Leslie, PhD – Anthropology University of Hawaii at Manoa May 23, 2003 This research is funded in part through a U.S. Health Resources and Services Administration, State Planning Grant to the Hawaii State Department of Health, Prime Contract No. 1 P09 OA 00046-01. Sub-Contract Research Corporation of the University of Hawaii, Project No. 659075. Research conducted by the University of Hawaii, Social Science Research Institute in collaboration with the Hawaii State Department of Health, Hawaii Institute for Public Affairs/Hawaii Uninsured Project and the Hawaii Health Information Corporation.

2. Being Uninsured in Hawaii – 2002-2003 Emergent Themes • Health and Health Care • Health Coverage • Obtaining and Maintaining QUEST • Unequal Treatment of the Uninsured • Substance Abuse • Additional Hassles • Optimism or Despair Preliminary results. Not for quotation, citation or further dissemination.

3. Being Uninsured in Hawaii – 2002-2003 Health and Health Care • Always seeking sources care • Always waiting for the next medical crisis • Fewer users of Complementary Medicine than anticipated • Feelings of unequal treatment from professional staff • Most have medical bills as major debt Preliminary results. Not for quotation, citation or further dissemination. 3

4. Being Uninsured in Hawaii – 2002-2003 Health Coverage • Those below or near to the FPL cannot afford health insurance as offered by commercial carriers • Decisions about being insured are rational and include factors such as current health, competing expenses, belief that their financial situation will get better • Health Insurance is seen as a mystery in terms of what i and is not covered • A continual need for dental services exists within this group • COBRA and other transitional arrangements for people are not well understood and are seen as too expensive Preliminary results. Not for quotation, citation or further dissemination.

5. Being Uninsured in Hawaii – 2002-2003 Obtaining and Maintaining QUEST • The application process is very demanding and often beyond the records of the applicants • Often it is the care provider that assists the individual to get QUEST coverage so that they can be paid • The effort required to maintain coverage is often as difficult as the original obtaining of coverage • The discontinuities in coverage often create health problems through non-compliance with chronic disease treatments • Once coverage is lost it seems to be more difficult to get it back than to originally get it Preliminary results. Not for quotation, citation or further dissemination.

6. Being Uninsured in Hawaii – 2002-2003 Unequal Treatment of Uninsured • When clinics become aware that a person is uninsured feelings of embarrassment and different standards of care emerge • Care providers are not seen as discriminating, their staff however, are described as treating the uninsured differently than other patients • Uninsured feel unwelcome at provider offices and wonder about the quality of their care • There is no one to talk to about these problems Preliminary results. Not for quotation, citation or further dissemination.

7. Being Uninsured in Hawaii – 2002-2003 Substance Abuse • Many of the uninsured are addicted. This is not a consequence of being uninsured but has serious ramifications in terms of their ability to access treatment • Being addicted often means that the person cannot divulge where assets and other funds have gone as they try to get QUEST • Being addicted opens the door to a much different risk profile in terms of opportunistic infections and compromised immune systems • Being addicted is used as a reason for not seeking work and for becoming unemployed. It also is seen as a problem not to be disclosed to QUEST workers Preliminary results. Not for quotation, citation or further dissemination.

8. Being Uninsured in Hawaii – 2002-2003 Additional Hassles • Oral health remains a problem and is almost universally defined as such • Transportation to and from jobs and clinics • Paying for expensive medications for chronic diseases • Keeping track – of renewal issues, bill payment, getting a job, raising a family, and in general, surviving • Always having to “tell your story” is embarrassing and depressing • Problems never seem to come alone Preliminary results. Not for quotation, citation or further dissemination.

9. Being Uninsured in Hawaii – 2002-2003 Optimism or Despair • Being uninsured is usually not a choice • Trying to become insured, once uninsured, is a real problem because with uninsurance come a number of other issues • Coping strategies such as believing that things will be better in the future are continually being described as “unrealistic” • Few, if any, social and health services offer support and assistance directly to the uninsured Preliminary results. Not for quotation, citation or further dissemination.

10. Being Uninsured in Hawaii – 2002-2003 Summary Findings • Uninsured people are realists and recognized that their status is not likely to change • Becoming uninsured seems to bring on many other related problems • The systems designed to address this problem appear to not be willing or able to accommodate to the needs of the uninsured Ideas • Can a system of care be devised that is able to accommodate to the needs of the uninsured? • Can services be available that are acceptable and of high quality but be affordable? • Can processes of application and renewal be supported with staff who know how to do it? Preliminary results. Not for quotation, citation or further dissemination.