Dialysis patient Manuel Sound needs 11 prescriptions for medication. Each month, he’s able to fill four.
He’s grateful that he’s allowed dialysis care under the recent Basic Health Hawaii plan, a state-funded plan that has been reduced after a compromise with the community it is targeted for: Compact of Free Association migrants. But it still limits his care.
"I need medication for high blood pressure. I need medication for cholesterol. I need medication for diabetes," said the 70-year-old Kalihi resident, who moved to Hawaii from Chuuk eight years ago. "I have to talk to my doctor about cutting down on the medication, because sooner or later I won’t be able to afford it anymore."
A class-action federal lawsuit was filed yesterday in an attempt to restore health benefits to Sound and about 7,500 Pacific island migrants in Hawaii.
Basic Health Hawaii, which went into effect in July, is a reduced benefits package created mostly for Compact of Free Association migrants. Residents of the Federated States of Micronesia, Republic of Marshall Islands and Palau can travel freely in the U.S. due to a 1986 federal agreement. In turn, the island nations gave the U.S. strategic military rights.
The state had initial plans for bigger cuts to benefits, including not covering lifesaving dialysis and chemotherapy treatments. A federal lawsuit from the migrant community, of which Sound was a main plaintiff, forced the state back to the drawing board.
BASIC HEALTH HAWAII
The Basic Health Hawaii plan, administered by AlohaCare, Hawaii Medical Service Association and Kaiser Permanente, offers four medications a month, including brand-name chemotherapy drugs, and provides the following annually:
» Twelve outpatient doctor visits
A federal judge issued a temporary restraining order on the state’s previous plan. Chemotherapy is now provided as part of the drug benefits in the current plan, while dialysis will be covered as a federally funded emergency service.
THE CRUX of the new lawsuit’s argument questions the constitutionality of providing inferior benefits due to immigrant status and duration of U.S. residency. The suit also alleges a violation of the American with Disabilities Act in that it forces migrants with disabilities to seek care in a hospital setting. It was filed by Lawyers for Equal Justice and firms Alston Hunt Floyd & Ing and Bronster Hoshibata.
"The state of Hawaii may not discriminate on the basis of national origin," said Margery Bronster, a partner with Bronster Hoshibata and former state attorney general. "Once the U.S. government allowed COFA residents free access to the U.S., no state could limit those rights."
State human services officials had not seen the lawsuit as of yesterday afternoon. Department of Human Services spokeswoman Toni Schwartz said officials will read the complaint before issuing any statements.
Under the Compact of Free Association, Hawaii, Guam, the Commonwealth of the Northern Mariana Islands and American Samoa share $30 million in funding to alleviate the burden the migrants may place on health, educational, social or public-sector services.
Guam has the largest share of the pot, with $16.8 million. Hawaii has $11.2 million, all dedicated to "supplement state funds to support indigent health care," according to the U.S. Office of Insular Affairs.
That is not enough for the state, which spends up to $50 million a year on medical assistance for migrants, said state Human Services Director Lillian Koller during a July interview with the Star-Advertiser, after the plan went into effect. The state spends about $130 million a year on total public services to migrants.
"There was no serious effort made to try to help Hawaii deal with this burden for so many years," Koller said. "The little bit we get now doesn’t even come close to what the costs are. It shows a real lack of political will."
Without the reduced benefits plan, which would save the state up to $15 million a year, layoffs and program cuts could occur, Koller said. The benefits should be funded in full by the federal government, she said.
"We are doing the best we can. We do care about all people who live here," Koller said, "but we have not been able to garner the help we need to offer what these people deserve."
Koller and Gov. Linda Lingle have made numerous requests for more funding, to the U.S. Department of Homeland Security and U.S. Sens. Daniel Inouye and Daniel Akaka.
"Many of these migrants arrive with health conditions that require costly and extensive treatment," Lingle wrote in a letter to Homeland Security Secretary Janet Napolitano in February. "They also arrive without adequate financial resources and without enough education or training to help them in obtaining employment. … The compact clearly provides that ‘it is not the intent of Congress to cause any adverse consequences for an affected jurisdiction.’"
Hawaii’s congressional delegation did gain the potential to bring in a so-called disproportionate- share allowance to local hospitals. The allowance is $2.5 million per quarter through December 2011.
"They have secured some significant federal resources to pay for uncompensated care provided in Hawaii hospitals that could be used to provide services for compact migrants," said Inouye’s spokesman, Peter Boylan. "However, the state needs to release the necessary matching resources."