Hawaii’s Micronesian community and health care providers are hoping the state will pay the out-of-pocket medical costs for migrants being switched from Medicaid to Obamacare insurance plans March 1.
A bill to do that was approved Tuesday by the Senate Human Services and Housing Committee.
Senate Bill 1327 and companion House Bill 1239 would require the state to pay expenses such as deductibles and copays for low-income residents who fall under the Compact of Free Association, which allows Micronesians to live and work in the United States. The compact was initiated in exchange for U.S. military rights, and to compensate islanders for the negative health and social impacts of nuclear testing after World War II.
The state Department of Human Services, which manages the Medicaid health insurance program for low-income residents, will move roughly 7,500 adult migrants to the Hawaii Health Connector, created by the Affordable Care Act to provide insurance for those with incomes too high to qualify for Medicaid.
The migrants are from the Federated States of Micronesia, Palau and the Marshall Islands.
The move will save the state an estimated $27 million a year because the federal government would primarily cover the costs of coverage, according to the legislative measures. The state will continue to cover aged, blind and disabled noncitizens as well as Micronesian children and pregnant adults.
Connector plans require enrollees to pay a share of the premiums and other costs, which would impose barriers to care for COFA migrants, many of whom are poor and have multiple chronic conditions, according to community health centers.
"Along with copays for medications, labs, X-rays, hospital visits and even primary care visits, the (Obamacare) plans in Hawaii will create enormous barriers to care for many if not most of the people being moved," David Derauf, executive director of Kokua Kalihi Valley Health Center, said in testimony to lawmakers Tuesday. "Deductibles and copays can create significant and even dangerous barriers to care for poor people."
Research shows that people in poverty won’t receive care if they can’t afford the copays and deductibles, he added.
"We can be reasonably certain that patients will not get the care they need, will suffer adverse events, will increase utilization of emergency services and hospitals, and will, in the long run, likely cost the system more," Derauf said. "Those of us who are middle- and upper-income might not appreciate the effects of these on low-income people who are faced with the decision to pay rent, feed their families or pay for medical care."
State Sen. Glenn Wakai (D, Kalihi-Salt Lake-Aliamanu), vice chairman of the Senate Health Committee, said at the hearing that at some point the governments in Micronesia must take care of their own people and "stop this one-way ticket to Hawaii."
"The approach they’ve been taking for decades now really has to be something they have to take responsibility for," he said. "Over time we’re going to ratchet down these copays and other benefits."
