Hawaii’s response to ACA repeal

For decades Hawaii has ranked among the top states for health insurance coverage due not just to our unique ERISA-exempt employer mandate but also to sizeable percentages of the population covered by Medicaid, Medicare, and military or veterans’ benefits.  Pre-Affordable Care Act, the non-elderly uninsured population was typically around 10%.  By 2016, the rate was down to less than 5%.  Among the newly insured were 40,000 individuals who were too affluent to qualify for Medicaid but weren’t eligible for employer-sponsored coverage.  Before the ACA gave them options, Hawaii’s insurance market didn’t have affordable health plans for them.

With recent coverage gains threatened by federal Obamacare repeal efforts, Hawaii legislators introduced bills to retain some of its most high-profile aspects in state law.  SB403 and HB552 started out as identical companions; each has crossed over with diverging amendments. Expect additional changes during the second half of the legislative session that reflect the terms proposed by Congress as the “American Health Care Act.”

While SB403/HB552 speak strongly to protecting consumer rights and benefits, many of the provisions outlined are have already been absorbed into the fabric of insurance policy here.  However, establishing either a refundable state tax credit or a premium supplementation fund for individuals will be a tough sell in a tight budget year.  And the legislature will really be challenged to off-set the calamities for families and our health care system if the federal proposal to hobble Medicaid succeeds.

The following table notes some of the prominent features in Hawaii’s legislative drafts and compares them with the federal proposal.