Hawaii Contingency Plans for ACA Repeal

Congress passed the Patient Protection and Affordable Care Act on March 21, 2010.  The very next day Republicans introduced legislation to repeal it, and when they took over as the House majority, they voted to repeal Obamacare more than 50 times.  However, the House couldn’t muster a repeal vote on March 23, the seventh anniversary of the day the ACA was signed into law, or the next day, and future action on the law is unclear.

On March 22, one day ahead of the expected repeal vote, Hawaii’s Senate Committee on Consumer Protection and Health (CPH) passed the House version of a bill to protect access to insurance for Hawaii residents.  HB552, HD1, SD1 creates a new gap group program and retains many ACA insurance regulations, but it also sets up a working group to consider the best course of action for Hawaii, should federal insurance requirements and funding disappear.

This seems particularly sensible since, even if Congress never manages to strikes down the ACA, the Trump administration is promising greater flexibility for state ACA and Medicaid waivers.  Accordingly, the group might consider better options to cover Compact of Free Association (COFA) migrants or other groups with special needs.

The working group is to be chaired by the CPH and House Health Committee chairs with vice chairs being the Senate and House Human Services Committee chairs.  Other members will be the Insurance Commissioner and directors of State Depts. of Labor & Industrial Relations and of Human Services with help as needed from the Depts. of Budget & Finance and of Taxation.  The Legislative Reference Bureau “is requested to provide staff, research, and drafting assistance to the working group.”  The group will hold public briefings and request expert input as needed.

As Chair Roz Baker described it, HB552, HD1, SD1 is a “Christmas tree” bill that would also:

  • Establish a minimum essential coverage premium supplementation trust fund to be administered by the Director of Finance.
  • Create the “Medicaid Plus” program to be administered by the Dept. of Human Services. Available to residents with incomes between 138.5 and 250% of poverty, enrollees would be responsible for an as-yet undetermined cost share and be covered by a minimal array of Essential Health Benefits (EHB) that include ambulatory,  emergency, hospitalization, pregnancy, maternity, and newborn, mental health and substance abuse, labs, preventive, wellness, and chronic disease management and limited prescription drug coverage.  Medicaid Plus will also cover contraceptive and breastfeeding needs.
  • Allow insurers to draw upon the supplementation fund to pay the difference between premium and enrollee shares.
  • Impose a penalty on Hawaii taxpayers or their dependents who are uninsured for one or more months of the year to be paid into the trust fund.

HB552 also seeks to retain other ACA insurance requirements, including dependent coverage by parents up to age 26, no pre-existing condition exclusions, no gender discrimination in premiums, and mandating the ten ACA EHB.