Bill would raise tax for in-home health care

State Sen. Rosalyn Baker hopes to push through a bill this year that would add a 0.5 percent surcharge to the statewide general excise tax to help cover the cost of in-home health care services for seniors and the disabled.

The bill, which is still being drafted, targets what health care policy experts say is a major gap in insurance coverage for seniors while also allowing residents who need help with daily tasks, such as bathing or making meals, to receive needed support while remaining at home.

Advocates for seniors crowded a legislative briefing at the state Capitol on Thursday to support the measure, which Baker (D, West Maui-South Maui) says would be the first of its kind in the nation and position Hawaii as a national leader on “social insurance” for long-term care.

However, with leadership in the House of Representatives saying this week that they won’t support tax increases this legislative session, the bill is expected to face resistance.

The measure would give qualifying seniors and the disabled a maximum benefit of $70 a day for up to 365 days to help cover health care services, such as home health care aids, or equipment such as walkers and ramps. The 365 days would not need to be consecutive.

The proposed GET surcharge would bring in about $250 million annually to a state trust fund, said Lawrence Nitz, a political science professor at University of Hawaii at Manoa who testified at the legislative briefing. The tax would go into effect in 2018, and the fund would be available in 2023.

To be eligible, Hawaii residents must have paid 10 years of state income taxes, though there would be limited benefits for people who don’t meet this threshold.

Seniors and family caregivers are often surprised to find that Medicare, the federal health care program for seniors, doesn’t cover most long-term care costs, said Kevin Simowitz, political director for Caring Across Generations, a national advocacy organization for seniors and the disabled.

In order to gain insurance coverage, middle-class seniors who can’t afford to pay for long-term care often find that they have to “impoverish” themselves so they can qualify for Medicaid, the federally and state-funded health care program for the poor.

“If the best option for middle-income families across the country is to spend down their savings to attempt to pay for the home health care they need, then the system really does beg for a new examination,” said Simowitz, who traveled to Hawaii to speak at the briefing. “Medicaid is intended to be a safety net for the low-income families and individuals in need of health care, not a backup plan for middle-income families.”

The average cost of facility-based care in Hawaii is $120,000 a year, he said. “So think, three or four people won that Powerball last week, and everyone else is in a tough spot,” he said.

But raising the GET will likely be a hard sell.

“My inclination is that it would be difficult to raise the general excise tax this year,” House Majority Leader Scott Saiki told the Honolulu Star-Advertiser in an interview after the briefing. “That’s not to say that long-term care services are not important. But given the fact that we extended the authorization for the rail tax, it may make it problematic to raise the GET again.”

Last year the Legislature signed off on a five-year extension of Oahu’s rail tax surcharge, allowing the 0.5 percent GET surcharge to expire in 2027 instead of 2022.

The Honolulu City Council still needs to approve the extension. (The GET on the neighbor islands is 4 percent; on Oahu it is 4.5 percent because of the rail surcharge.)

Saiki (D, Downtown-Kakaako-McCully) added that earmarking tax dollars for a specific program isn’t always ideal because it limits the Legislature’s ability to address the state’s multiple needs.

“There are a lot of competing needs in our state, and those needs are important to a lot of different kinds of people,” he said. “And it’s really up to the Legislature to allocate and appropriate funds to address these competing needs.”