In this edition of “5 Things We’re Watching,” we take a look at health items on Gov. Ige’s intent to veto list, feature coverage on NHPI health disparities, and examine the impact of inflation on health care.
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State of Reform
1. Health policy on Ige’s intent to veto list
A bill that permits health insurers to cover telephonic behavioral health services is among the 30 bills on Gov. David Ige’s intent to veto list. Ige says the bill language is too vague and may prompt insurers to “restrict or exclude coverage for telephonic services due to concerns of compliance with this bill.”
Some health care organizations are urging Ige to reconsider, arguing that the bill will instead increase access to care by creating a distinction to allow for reimbursement of telephone calls. Hilton Raethel, President and CEO of the Healthcare Association of Hawaii, told State of Reform: “We believe the benefits far outweigh the potential risks in terms of potential abuse.” Other health-related bills on Ige’s list include HB 1570, which would ban the sale of certain flavored tobacco products, and SB 2032, which establishes the Hawai’i Genetic Information Privacy Act.
2. Inflation’s impact on the social determinants
“Excess inflation” is costing Hawaii residents $1,763 to $7,206 per year, according to a recent UHERO analysis that examined the impact of inflation on Hawaii households. From a health perspective, Dr. Steven Bond-Smith, a co-author of the analysis, says Hawaii has experienced a 10% inflation rate on medical care since last year. He says, however, that individuals might not necessarily feel the increase, which could be offset by the long-standing Hawaii Prepaid Health Care Act.
Bond-Smith also notes that inflation pressures on housing, transportation, food, and other social determinants of health can cause some individuals, particularly those in lower-income groups, to defer medical care and prioritize more immediate needs. “People might forgo some health care costs because food and shelter and fuel is more important,” Bond-Smith says. “It’s probably more likely for certain types of care as well. Dental care, for instance, might be something that [individuals] forgo much more quickly.”
3. Nearly 1 in 4 Healthcare.gov in-network claims denied in Hawaii
A recent Kaiser Family Foundation analysis found that 18% of claims submitted for in-network services in the US were denied by HealthCare.gov marketplace insurers during the 2020 plan year. In Hawaii, that denial rate was even higher at 24%.
According to the analysis, national denial rates for in-network claims ranged from 1% to 80%. About 10% of denials were due to lack of prior authorization or referral, 16% were for excluded services, and 72% were for “all other reasons.” KFF’s evaluation also notes that consumers rarely appeal denied claims, stating: “Of the more than 42 million denied in-network claims in 2020, marketplace enrollees appealed fewer than 61,000 – an appeal rate of about one-tenth of one percent.”
4. Adult Medicaid dental benefits expected in 2023
Med-QUEST Division Administrator Dr. Judy Mohr Peterson announced late last month that after more than a decade, full Medicaid dental benefits will be returning to adults in Hawaii. Facing budget challenges brought on by the Great Recession, preventative and restorative adult dental benefits were cut in 2009. With the passage of the FY 2023 Executive Supplemental Budget this past legislative session, Med-QUEST received over $25 million in total funds to expand services, including the restoration of full dental benefits for adults.
According to Peterson, the benefits will include basic preventative services such a teeth cleaning, X-rays, and exams. Basic restoration procedures for chewing functions, fillings, and crowns will be covered as well. Med-QUEST is aiming for coverage to begin in January 2023, but will need federal approval. Med-QUEST sent a pre-submission draft to CMS on June 6th.
5. Data disaggregation and Pacific Islander health
Accurate representation of Native Hawaiians and Pacific Islanders is sorely needed in the health care system, especially as the long-term impacts of the COVID pandemic continue to arise, says Native Hawaiian oncologist Dr. Kekoa Taparra. During a recent presentation, Taparra discussed the historical context that has led to present-day health disparities in these communities, and ways to address disparities going forward.
Part of the problem, he says, is the tendency for researchers to lump NHPI individuals with Asian individuals, which can mask disparities and limit representation in clinical trials. In terms of solutions, Taparra recommends more culturally aware trials that disaggregate NHPI data as its own unique group. He also advocates for increased NHPI representation in the health care workforce.