Don’t let snafus botch health coverage

The Affordable Care Act was conceived on a national scale as the means to a just and desirable end: making health care more accessible to more Americans. Ironically, for Hawaii, a model state with a truly admirable record of providing health insurance coverage to its population, the ACA — “Obamacare” — has been a poor fit.

One of the repercussions of that fact could unfold over the coming months: Those recently insured through the Hawaii Health Connector, slated for shutdown, may face a bumpy ride making the transition to the federal exchange. State officials must work quickly to ensure that these people, especially those on the lower end of the income scale, don’t fall into the uninsured class.

The Connector, the nonprofit authorized by the state to run the online insurance exchange where policies are sold, is being dismantled because it falls short of federal sustainability standards. Gov. David Ige decided to transition enrollees to the federal exchange, which is now linked to the state’s online Medicaid eligibility portal.

That was the right choice, while a painful one: Nearly $300 million was spent on the Connector and the eligibility portal. The Connector simply lacked the market of uninsured potential customers that elsewhere can sustain a state exchange. While it’s been an obscene waste of money, wasting even more to prop up the Connector makes no sense at all.

But the work of the administration can’t end there. Shifting enrollees over to the ready replacement — the federal exchange, Healthcare.gov — will require intense outreach by the state, an effort that must ramp up immediately.

Already there is concern among social service agencies that many of the needy will fall between the cracks. Dr. David Derauf, executive director of Kokua Kalihi Valley, said some of the rules about enrollment are more stringent for Healthcare.gov, which some of his poorest clients will find difficult.

For example, the Micronesian migrants living in Hawaii under the federal Compact of Free Association need to enroll in Obamacare — most don’t qualify for Medicaid — through the federal exchange. That system requires address verification, and some who are skirting public-housing rules by staying with relatives, can’t confirm that address.

He is rightly concerned that such people simply won’t be enrolled. That will draw more from the public purse when uninsured patients end up untreated and needing more expensive care later.

Businesses that bought coverage through the Connector are struggling, too, and they need information to smooth the transition as well. That’s because the open enrollment period begins Nov. 1 and some businesses with employees enrolled through the Connector aren’t sure what’s happening next.

The good news — and it needs to get out more broadly — is twofold, said Laurel Johnston, Ige’s deputy chief of staff. Some administrative staff of the Connector will remain through the end of June, and one of its primary tasks is to continue the outreach, especially to low-income enrollees such as the COFA migrants.

Second, businesses this year simply may enroll directly through the health-insurance providers, as they have for decades under the state’s Prepaid Health Care Act. Johnston said federal authorities have essentially waived the requirement to enroll through the federal exchange’s Small Business Health Options Program (SHOP), which provides limited tax credits to make the policies cheaper.

This year Hawaii businesses can still receive the tax advantage, but it will be calculated off the exchange by the federal government, Johnston said.

Ultimately the hope is that Hawaii will get that requirement permanently lifted, once the ACA makes the formal waiver available starting in 2017. The Ige administration has drafted an application that officials expect to submit after the rush of this enrollment period, preserving most of the law’s provisions other than SHOP.

At the end, Hawaii should re-emerge from all the ACA disruption with a broad-based health care system that works more efficiently. But it will take clearer communication from the state and full-scale outreach to get to that point, without people losing their health coverage along the way.