Hawaii was the only state in the country to record a significant increase in uninsured children from 2009 to 2011, according to a new study.
The number of children without health insurance soared 55 percent to 10,980 last year from 7,066 two years earlier, according to a report published in October by the Georgetown University Health Policy Institute Center for Children and Families.
But the reason for the jump is unclear.
"We’re really unable to pinpoint what caused uninsured rates to go up. There’s really no way of knowing," said Robert Hirokawa, chief executive officer of the Hawaii Primary Care Association, whose mission in part is to decrease the number of uninsured children.
One theory is that Hawaii’s poor economy may have contributed to families losing health coverage.
"Overall there’s been an increase simply because a lot more people are losing jobs, losing hours or maybe are not able to afford premiums," said Kathy Suzuki-Kitagawa, Hawaii Primary Care Association’s chief operating officer. "It’s important to note that it wasn’t just children who experienced an increase in uninsured status during this time; it was adults too."
The Hawaii Primary Care Association is a nonprofit organization that supports community health centers in Hawaii.
Hawaii’s community health centers saw a 15 percent increase in patients without insurance between 2011 and 2009, Suzuki-Kitagawa said. The number of uninsured patients, both adults and children, rose to 33,911 from 29,618.
Even with the recent increase in the number of uninsured children, Hawaii has one of the lowest rates in the nation. Only 3.6 percent of Hawaii children were uninsured in 2011, which was lower than all but three states.
The national rate of uninsured children was 7.5 percent in 2011, down from 8.6 percent in 2009. Thirty states saw no significant change in rates of coverage, while 20 states posted substantial declines in the rate of uninsured children between 2009 and 2011, the report said.
Martha Heberlein, co-author of the Georgetown study, said while Hawaii has one of the lowest rates of uninsured children in the country, it must be careful not to lose that distinction.
"This is a flag. Hawaii’s been doing so good for so long in covering kids. You have to look at the larger picture and think, ‘What can we do to stem this decline?’" she said. "We’ve got to keep an eye on this and figure out what’s going on so that we stop it before it gets worse."
A separate survey in the 2012 Kids Count Data Book, comparing the number of kids without health insurance in 2008 and 2010, showed the number of uninsured children in Hawaii remained flat at 4 percent.
Most children in Hawaii whose parents are unable to provide private insurance are eligible for coverage through Quest, a Medicaid program, at no cost to their parents.
Medicaid increased its coverage of children by 15,000, or 12.6 percent, from 2009 to 2011, the state Department of Human Services said. DHS’ Med-QUEST division, which administers the Quest program, had 140,471 children 18 years and younger enrolled as of Oct. 30.
By 2014 the intent of the federal Affordable Care Act, often called Obamacare, is that all Americans will have a source of health coverage, whether through an employer, Medicaid or a new health insurance exchange. The exchange, part of Obamacare, is an online marketplace where individuals and businesses can purchase health plans from competing carriers at subsidized rates.
"Our hope is that as health care transformation takes place in Hawaii and across the whole country, the number of uninsured would start to level off," Hirokawa said.
One agency whose mission was to make sure Hawaii’s keiki have health coverage was shut down earlier this year.
Hawaii Covering Kids, a project of the Hawaii Primary Care Association, lost its funding in June. Hawaii Covering Kids had helped identify, enroll and retain eligible children in health insurance programs since 1999. The program has been folded into Hawaii Primary Care Association’s general outreach project, which focuses broadly on enrolling low-income residents in health insurance among other public benefit programs.
"That was very sad. They actually did an outstanding job in identifying within the schools … whether (students) had insurance or not," Sen. Suzanne Chun Oakland, D-13th (Kalihi, Nuuanu), said of the loss of Hawaii Covering Kids. "Why there was a decision to not fund or support their own program, I don’t know. It would’ve been good to keep Hawaii Covering Kids only because of the track record they had."
The state Department of Human Services had two contracts with Hawaii Primary Care Association before July 2011, with $70,000 going specifically to Hawaii Covering Kids and $1 million for general outreach and education. Those contracts have been combined into a $1 million contract with a "continued focus on children," DHS said.
"We’re still fulfilling the mission of Hawaii Covering Kids. We’re trying to figure out how to transition the project," Suzuki-Kitagawa said. "We’re still in the process of trying to figure out what is the best way to leverage our dollars to help the most people. It’s more comprehensive because you’re not only assisting children, you’re assisting parents so the entire family is being helped."
