Lawmakers in some blue states like Hawaii are scrambling to create their own versions of federal health care legislation in the face of President Donald Trump’s commitment to repeal those laws.

The Hawaii Legislature is considering proposals to protect — or in some cases resurrect — the most significant effects of the federal Affordable Care Act of 2010. Senate Bill 2924 establishes a so-called individual mandate, which requires most people to be insured or face tax penalties.

The mandate is intended to force everyone to purchase insurance. This keeps premiums lower by adding healthier people to the insurance pool.

Co Chair Senator Roz Baker makes a point during Marijuana working group meeting held at Capitol room 329. 13 dec 2017
Sen. Roz Baker introduced a bill to make state law mirror the Affordable Care Act’s prohibition on insurance companies discriminating based on health ailments or gender. Cory Lum/Civil Beat/2017

Tax legislation passed by Congress last year will allow the individual mandate provision of ACA — or Obamacare — to expire at the end of this year. Hawaii is one of about a half dozen states that are attempting to implement their own individual mandates, the Atlantic reported.

Senate Bill 2340 is another ACA-related measure that seeks to prohibit insurance companies from discriminating based on health ailments or gender, and allow people ages 25 or younger to be covered by their parents’ health insurance. It was introduced by Sen. Roz Baker as part of the Women’s Legislative Caucus package.

“The current presidential administration campaigned on a promise to repeal the Affordable Care Act, and certain members of Congress have supported that approach, which could have widespread and devastating ramifications,” says SB 2340, which later states “it is vital” to preserve certain parts of the law.

Written testimony on a slew of bills that would allow the state to copy aspects of the ACA has been overwhelmingly supportive.

SB 2340 “really should not be a controversial bill,” said Nicole Woo, senior policy analyst for the Hawaii Appleseed Center for Law and Economic Justice. “The point of this law is to keep things the same.”

Woo pointed to the center’s written testimony, which spotlights research suggesting that the ACA led to better health among low-income adults.

Hawaii already requires employers to provide health insurance to employees working at least 20 hours per week. The state has “a history or legacy” of setting progressive health policy and residents have a longer lifespan compared to other states, she said.

“For me, it is important to capture all the great parts of the Affordable Care Act … to ensure that health and safety” is protected, said Department of Human Services director Pankaj Bhanot, whose department oversees distribution of funds for the federal Medicaid program serving needy, disabled and elderly patients.

Setting The Table

Other Hawaii bills related to the ACA don’t copy the federal law, but seek to pave the way for the state to implement such a program if necessary.

If Hawaii wants to create unique health care programs that differ from ACA, it must apply for an “innovation,” or exemption, waiver. Innovation waivers allow the state to adopt its own health care policies, but they must be at least as effective and affordable as ACA.

Hawaii was the first state to receive an innovation waiver under ACA. 

SB 2199 authorizes the state to ask for another exemption. This one would allow the state to essentially insure insurance companies, protecting them from costly, high-risk patients. An affordable health insurance working group recommended that the state control health care costs for everyone by protecting insurance companies from costly customers.

Alaska, Minnesota and Oklahoma already have such programs, according to the working group.

SB 2199, SB 2924, SB 2340 are slated to be heard by the House Health and Human Services Committee on Tuesday morning.

Another set of bills, SB 2788 and HB 694, would create and fund a database to help the state analyze health care trends and costs for patients of Med-QUEST, the state office that carries out the federal Medicaid program.

When Congress weighed repealing the ACA last year, the Department of Human Services had to do several data analyses in an attempt to predict the impact on Hawaii insurance rates, said Judy Mohr Peterson, the director of Hawaii’s Medicaid program. That’s why the department requested the bill.

“If we had a program like that … it would have helped us a lot in understanding rates over time,” she said, adding that such a database would benefit the department even if the ACA remained intact at the federal level.

Having such a database could provide the state with more information on the “social determinators” that create health disparities, Bhanot of the Human Services Department said.

“Knowing what our current healthcare costs are is essential to determining ways to reduce future costs,” wrote Romala Sue Radcliffe, head of the State Health Planning and Development Agency, in testimony on SB 2788.

An earlier version of the bill asked for $800,000 in state funds for personnel costs and $600,000 from federal funds to gather the data, but it was amended to include unspecified dollar amounts.

SB 2788 has not been scheduled for a hearing, but HB 694 passed out of the Senate Human Services Committee on Monday.

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