5 Things Hawaii: Senate committees, Elections, I got COVID

To paraphrase Churchill, it does not feel like this is the end of our election and national political strife. Perhaps this isn’t even the beginning of the end. Perhaps, this is the end of the beginning. Legal contests of the elections are building. Tighter congressional majorities will demand greater party orthodoxy to keep functional caucuses together. Taken together, it means more division ahead, not less.

If we are going to reform health care, it will take more understanding, not less; more collaboration and cooperation, not less. This is perhaps even more true when it comes to reforming our unique American republic.





With help from Emily Boerger

1. A run down of notable elections’ outcomes

Democrat and public health professional Lisa Marten won 52.5% of the vote in her campaign for the open seat in the 51st legislative district. However, public health leader Trish La Chica lost a close race as a Democrat against Val Okimoto in the heavily Republican 36th district.

Meanwhile, control of the US Senate will come down to Georgia (of all places to have tight races) and Republicans will pick up seats in the US House. House Republican Leader Kevin McCarthy makes a compelling argument about House Republicans’ success with 7 pickups and as many as 11 more possible. Meanwhile, Nancy Pelosi faces pressure to step down from her left and right flanks, something likely to build in the weeks ahead.

2. New MedQUEST RFP out next month

MedQUEST plans to tentatively release the new QUEST integration RFP in early December. It will be due roughly 8 weeks later in early February.  The target award is in early March followed by implementation for July 2021.

In the 161 pages of “condensed” responses to an RFI regarding the solicitation, a number of stakeholders wanted a uniform number of plans across the state without regional variation. HMSA “recommends that the number of health plans stays consistent with the current QI contract.” AlohaCare wrote “We believe the current number of plans will best support anticipated increases.” HPH said the “optimal number of state plans would be no more than three (3) plans… Preferably no for-profit insurers.”


3. Plan to save ACA may be scuttled

Next week, SCOTUS will hear California v. Texas. If the ACA is overturned come June, Hawaii is at risk to lose up to $400 million annually which it receives under the legislation. That would mean about 86,000 Hawaii residents could lose insurance overnight. In a state like California, some think this would cause a “death spiral” for the rest of the health care market. My guess is the Pre-Paid Health Care Act and ERISA waiver in Hawaii would provide enough of a backstop that the broader Hawaii market could endure the sudden change.

US House Democrats had a quiet plan to try to save the ACA next year. They planned to vote to increase the individual mandate penalty at the center of the legal challenge. By re-establishing the penalty at a number greater than zero, the constitutional grounds for overturning the ACA would be eliminated. Strong wins in November, so the argument went, would make the voter mandate to keep the ACA clear. However, without a Senate majority, Democrats are unlikely to get a vote on a new penalty. In any case, this election has not delivered a clear federal mandate for anything, leaving the strategy more theory than soon-to-be-practice.

4. I got COVID. Here is what I learned.

Over the last few weeks, I was diagnosed with COVID. I quarantined in my home office with light but still-worrying symptoms. While the disease was jarring, even more disappointing was my experience with the primary care and public health systems. I’ve written before about how good the care was for my uncle when he was 38 days on a ventilator.

But, it’s clear to me now that if you get COVID, you’re mostly on your own. Testing is still a mess in many cases, and varied across communities. Even the protocols don’t seem to make sense. For example, if you come in contact with someone with COVID, but you test negative, the protocol is to quarantine for 14 days. If you test positive, you only need to quarantine for 10 days. I know the reasons why this might be the case still, but the gold standard is two negative tests about five days apart. With more testing, we can dispense with this 14-day requirement and better support people in managing through this crisis.


5. Shift in committee assignments in Senate

The Senate announced yesterday that it would create a new committee for the 2021 legislative session dedicated to health care. The Senate Committee on Health will be led by Sen. Jarrett Keohokalole of Kailua. Health as a policy issue had previously been in Sen. Roz Baker’s committee. She will serve as the Vice Chair of the Committee on Health, and continue to Chair the now-more-narrowed-in-scope Committee on Commerce and Consumer Protection.

I don’t know what happened in caucus, but this sort of thing doesn’t usually happen this way. It strikes me as very much the move of a gracious team player, something for which Baker should probably be commended. No word yet from the House on how it intends to re-organize.