Hawaii lawmakers are worried about the sustainability and accountability of the Hawaii Health Connector, the state’s quasi-government nonprofit agency that’s in charge of implementing the Affordable Care Act.

Legislators questioned health officials during an informational briefing at the state Capitol on Wednesday.

Like elsewhere in the country, the beleaguered agency has struggled to implement the new national health care law which is better known as “Obamacare.”

The nonprofit’s executive director, Tom Matsuda, has been on the job for less than a week. The agency’s initial executive director Coral Andrews resigned on Dec. 6 amidst criticism of her management.

In addition, just a few hundred people have enrolled through the Hawaii Health Connector since the website launched on Oct. 15, despite nearly 100,000 residents being uninsured.

But Hawaii officials said Wednesday that despite some problems, Hawaii isn’t doing too poorly compared with the rest of the nation.

The hearing comes a day after Department of Health director Loretta Fuddy was killed in a plane crash off Molokai. Fuddy had a key role in the new insurance exchange.

Hawaii Chief Information Officer Sonny Bhagowalia told lawmakers Hawaii is in the middle of the pack compared with other states in terms of the stability and effectiveness of its implementation.

People are now able to enroll through the website and even those whose previous plans were cancelled have had them reinstated.

Still, lawmakers said that they’re concerned about the agency’s transparency and sustainability, as well as rising costs.

Rep. Della Au Belatti said that as a nonprofit, the agency may not be subject to the state Sunshine Law even though it’s funded by taxpayer dollars.

She wants to see the agency’s data and budget, and she’s drafting legislation that increases the disclosure requirements for the agency.

Rep. Bertrand Kobayashi criticized the amount of money that has been spent so far. The agency has received more than $200 million in grants and already nearly half of it has been spent or obligated.

“To me sounds like you’re spending $10,000 per completed application,” he said. “How do you justify that?”

Matsuda said that such a calculation is misplaced.

“When you buy a car, you can’t really measure the value of what you spent on the car in the first five days you’ve driven it,” he said.

But he did say that his top priority is increasing the number of enrollees.

Some lawmakers urged Matsuda to consider paying brokers, like some other states are, to help attract more enrollees. The current outreach efforts only enlist brokers on a volunteer basis.

Bhagowalia, the chief information officer, agreed that more needs to be done to improve the sustainability of the program.

“You can do the math and it’s pretty obvious that there’s a rising wave that’s coming and I don’t think we can sustain it,” he said.

He said the state needs to consider integrating its healthcare technology systems as well as potentially creating a state agency to manage the program, rather than maintaining the nonprofit.

Rep. Justin Woodsen said he recognizes that the program requires high upfront costs but asked Insurance Commissioner Gordon Ito when he expects to see a decrease in costs. People who don’t have health insurance next year will have to pay a fine of $95 per adult or $287 per family.

The answer wasn’t reassuring.

“Your guess is as good as mine,” Ito said. “Unless we address the cost drivers we’re going to see 6, 8, 10 percent cost increases every year.”

Apart from concerns about the health care law, the mood of the briefing was somber following the passing of Fuddy.

Fuddy held one of four state positions on the board of Hawaii Health Connector.

Matsuda said that while Fuddy’s passing doesn’t have any immediate impact on the organization’s day-to-day work, she played a key role in charting the agency’s path.

“She brought a wealth of knowledge about public health generally into the board’s discussions,” he told Civil Beat. “It’s a loss of a voice that has a lot of wisdom for this area. That’s a huge gap.”

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