“Coverage is Confidence”

1. “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 *

2. 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 *

3. 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 *

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

5. 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 *

6. 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 *

7. 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 *

8. 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 *

9. 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 *

10. 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 *

11. 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 *

12. “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 *

13. 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 *

14. 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 *