I began my career working with keiki, and before I came to Bay Clinic, I worked with kupuna at the Hawaii County Office of Aging. I have seen firsthand how important it is for these populations to have access to health care, especially keiki with mental or behavioral health issues and kupuna with chronic conditions.

 

When we talk about the importance of caring for our community, I think about how keiki and kupuna would be affected if safety net programs like QUEST and federally qualified health centers didn’t exist — or worse, if they couldn’t serve all the people who needed it.

In addition to our youngest and oldest members of society, pregnant women and low-income adults, and blind or disabled individuals all depend on QUEST for their health care benefits.

That’s why it was shocking to me to hear that the state Department of Human Services planned to cut the number of health plans serving neighbor island QUEST patients from four to two plans on Hawaii Island. Under normal circumstances, that would have a major effect on the health care system.

A screen shot from the website of the DHS Med-QUEST Division. During the COVID-19 pandemic, the department should ensure there are enough Medicaid plans for needy residents.

We already have a shortage of providers, and not all providers accept all QUEST health plans. Shrinking the network of QUEST providers would make it even more difficult for QUEST members to find a doctor.

The COVID-19 pandemic hasn’t just impacted our health system, it has left 37% of our workforce unemployed. Unfortunately, the economic toll of the pandemic will be felt by many families.

Thousands of people who were barely living paycheck to paycheck before COVID-19 have or will surely fall into poverty, and the recovery will take years. Our social safety net for those in need is now more important than ever.

New Beneficiaries

Over the past month, more than 16,000 new beneficiaries have enrolled in QUEST, and that number is expected to rise by 2,000 per week. Experts are estimating that by the end of the year, there will be anywhere from 44,000 to 101,000 new QUEST enrollees.

Many enrollees will be on Oahu, which will still have all four plans available. But for neighbor islands, DHS wants to limit options to two health plans. We need more providers and plans, not less.

If DHS moves forward with its original plan to cut the number of health plans available for neighbor islands, our community will face a full-blown health care crisis.

On the one hand, we will have between 44,000 to 101,000 new QUEST beneficiaries that will need to be served. On the other, we have 50,000 QUEST beneficiaries that will need to change their insurance plans because their health plan will no longer be offered.

If you look beyond those numbers, you will see a family in East Hawaii whose mom and dad have lost their jobs due to COVID-19, and who may need to fly their child to Oahu to see a specialist pediatrician that accepts their health plan. You will see a kupuna who doesn’t understand why she needs to switch providers when she’s been seeing her doctor for 20 years.

You will see patients with physical and mental disabilities who can’t get the help or care they need because switching insurance plans is too difficult. Unfortunately, you will see some patients forgo care because they couldn’t find a doctor taking new QUEST patients.

DHS’ decision will also take away QUEST members’ access to important health services, which will have a negative impact on the health of our residents. For example, many of Bay Clinic’s patients receive free basic adult dental coverage through AlohaCare.

DHS must recognize our current situation is totally different.

Restricting AlohaCare from operating on neighbor islands will mean that thousands of patients will lose their access to covered dental services. Oral health is already one of the largest unmet health care needs in Hawaii, and without access to free dental care, even more patients will suffer from related conditions like gum disease, poor nutrition or infection.

I understand that DHS’ decision to remove AlohaCare and Kaiser Permanente from providing Medicaid insurance to neighbor island residents was intended to cut back on administrative tasks for physicians and providers, but this decision doesn’t put patient needs first. This decision was made earlier this year, before the first coronavirus cases in Hawaii were announced.

Now it’s clear that the situation has changed. DHS must recognize that our current situation is totally different now and I ask that they take this opportunity to protect the health of all of Hawaii’s people — not only those on Oahu. As a state, we can do better for our keiki, kupuna and those in need.

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