When it comes to health care transformation that promotes high-quality care for all, the Abercrombie administration strongly supports the goal of "universal coverage."

This simply means that every state resident has access to health insurance that provides a meaningful level of benefits.

These benefits could be as a result of our state’s time-honored Prepaid Health Care Act, via Medicaid or Medicare, through the military or Veterans Administration, or self-insurance.

The concept of "universal coverage" is often confused with the concept of a "single payer" system, where all health care is paid for by one entity, usually the government.

Universal coverage is an important foundation for a better, more cost-effective health care system for several reasons.

First, people with insurance are more likely to receive the care they need when they need it, and that’s a very good thing for both the individual and the system.

Second, it’s important to get the sick and the well, the young and the old into the risk pool to increase overall affordability and predictability of coverage.

Third, full insurance leads to a better, more economical system of care, since insurers respond to regulations that require them to cover certain benefits, increase transparency, and limit their overhead and profit.

The close link between insurance coverage and health care system improvement is at the heart of the federal Affordable Care Act (ACA) and the reason that the act reformed many aspects of health insurance and invested so heavily in insurance exchanges.

We continue to support the many positive attributes of the ACA.

But, as we are learning, some of the requirements for the ACA insurance exchange which in our state is the nonprofit Hawaii Health Connector were not compatible with our small but advanced marketplace.

We are actively looking at the opportunities available to us through a waiver of some of the requirements in the ACA.

Starting in 2017, the law allows the state the flexibility to receive an innovation waiver to pursue alternate strategies to ensure all residents have access to high-quality, affordable health insurance.

This would require Hawaii to devise a plan that ensures coverage is at least as good, affordable and available as it is under the ACA.

In addition, any waiver developed would have to be presented to the public for comment, and the state Legislature would have to explicitly approve all provisions.

Hawaii has long been a leader in health care coverage, and we believe the waiver development opportunity will help us to build on the unique successes achieved with our Prepaid Health Care Act, our growing Medicaid program, and ACA-required insurance reforms already in effect.

The health care system is changing in many positive ways, and this opportunity adds improving the functions of health insurance to the other strategies that are transforming our whole health care delivery system.

In combination, expand-ed coverage, improved services and reformed payment will result in higher quality, better health and greater cost-effectiveness.

Universal coverage is a worthy goal and we look forward to achieving it to benefit the people of Hawaii.

For more information about the Hawaii Health Innovation Plan, visit hawaiihealthcareproject.org.