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“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

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Coverage is confidence
“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

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


Envisioning health coverage based on

Envisioning Health CoverageBased On:

  Interviewees’ self-identified health coverage needs and perceptions.

Interviewees talk story about the health care system in Hawai’i.

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


Research questions
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?

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


Health coverage ideals
Health Coverage Ideals

  •  Affordable

  • Accessible

  • Equitable

  • Flexible

  • Understandable

  • Uninterrupted

  • Worthwhile

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


Affordability is a key issue
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

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


Accessibility
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.

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


Equitable
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

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


Flexible
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.

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


UnderstandableCurrent 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”

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


Understandable how
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

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


Understandable how1
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;

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


Uninterrupted
“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.

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


Worthwhile
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.

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


Coverage is confidence1
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.

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


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