Issue Position: Health

Issue Position

HEALTHCARE FOR EVERYONE IN HAWAII

In 1974, Hawaii passed the Prepaid Healthcare Act which required employers to provide health insurance to full-time employees.

This law has helped Hawaii maintain one of the lowest uninsured rates in the country and one of the healthiest, longest living populations. We were ahead of our time, and our law has been considered a model for national healthcare reform.

But when the law was passed in 1974, many believed that universal healthcare in the United States was right around the corner. Most people in Hawaii already had health insurance through their employers, the monthly premium for a single plan was $15.96, and the economy of Hawaii was on the rise.

Times have changed radically. We are living longer with more health complications, our struggling economy has more small- and medium-sized employers, new technologies and pharmaceuticals are in high demand, and costs have exploded in ways we never imagined as more people are living longer than ever before.

Our system of healthcare is fragmented, medical professionals are finding it harder to build a career in Hawaii, insurance costs are crippling business here, rising costs threaten the solvency of the retirement systems, it is harder to make an appointment with your doctor, co-payments are rising, and more people, particularly the most vulnerable in society, are finding it nearly impossible to access any health care at all.

With the kind of vision we had in 1974, and the kind of cooperation only possible in Hawaii, we can devise a health policy that will once again be a pioneer for the nation. We'll build on our strengths: outstanding health professionals who have been leaders in evidence-based practices and community-based medicine; a strong network of Community Health Centers and community-based hospitals; the perfect climate and culture for healthy living; near universal insurance coverage provided principally by two nonprofits with a long history and commitment to Hawaii; and national healthcare reform full of opportunities for our state.

In an Abercrombie Administration, we will focus on first things first--ensuring that all people have access to quality healthcare, addressing the root causes of poor health, and concentrating on prevention and public health education. At the same time, we will collaboratively develop a blueprint to serve all people of Hawaii under a universal system that integrates the best aspects of our private and public systems of care. We can build a model system that will once again lead the nation in its ingenuity and foresight. The challenges in front of us are clear. All we need now is the commitment and cooperation to get it done.

The Abercrombie Plan
Build on Every Federal Healthcare Reform Opportunity for Hawaii

The legislation signed by President Obama creates new requirements of the states, for which we must be prepared. It also has numerous opportunities to obtain federal help in upgrading our system of healthcare by improving care for the needy, expanding the use of health technologies, increasing numbers of health professionals, supporting seniors and small businesses, and securing funding for hospitals and health centers.

Expand Community Health Centers

Hawaii has an outstanding array of Community Health Centers that are providing much more than physical health services to people. Their success is even more remarkable when you consider the tremendous fiscal constraints they are having now, coinciding with a huge increase in demand for services. We need to build on what is working. Community Health Centers are critical magnets for serving people throughout our mostly rural state. Federal, private, and state funds can help build capacity in these centers so that they can provide culturally appropriate, accessible healthcare, mental health care, wellness programs, dental services, health education, and other social services in a holistic manner that is relevant to the individual, family and community. Boosting their capacities, use of technology, personnel, and facilities will make all Community Health Centers even more significant fixtures and leaders in their respective communities.

Address the Physician Shortage

Hawaii has only 2,600 full-time practicing physicians. We currently need 3,400 and at the rate we are going, we will be 1,500 physicians short by 2020. This problem is worse on the Neighbor Islands, and we have critical shortages in orthopedists, obstetricians, and oncologists. Our medical school is not producing physicians fast enough, and the majority of our graduates and residents are leaving the state for work. We must act quickly to increase enrollment at our school of medicine, provide loan forgiveness and repayment assistance for service in Community Health Centers or HHSC hospitals, and provide incentives such as housing subsidies to attract and retain health professionals in underserved areas. We must increase the deployment and use of physician extenders, mainly physician assistants and nurse practitioners. We can establish a physician assistant program at UH-Hilo and increase other training opportunities to double the number of physician assistants by 2015.

Expand the Use of Information Technology in Healthcare

Our nation's current healthcare system has the highest administrative costs in the world. Health plans, hospitals, and providers must be brought together to reduce administrative costs, eliminate duplicative and unnecessary procedures, and effectively use the Internet and health information technology. Building local capacity to develop health information technology supports existing programs at the University of Hawaii and in the private sector, and generates jobs to attract talent and keep our best and brightest in our community. Health information technology is a national movement, and Hawaii's remote and rural character is the perfect proving ground for best practices. We must be at the forefront of this movement.

Rebuild the Public Health Infrastructure with a Focus on Children

Hawaii's public health infrastructure has been decimated over the years, leaving us less prepared for epidemics and limited in our approach to public health education. We have been unable to provide the kind of outreach needed to address disparities and aggressively combat preventable health problems that wind up costing us more public dollars in the future. These include obesity, chronic diseases such as diabetes, oral health problems, and substance abuse. We will begin the process of rebuilding public health infrastructure by reestablishing the School of Public Health at the University of Hawaii, which used to serve the entire Pacific region. Without the School of Public Health, there has been a decline in overall population health in Micronesia, the Marshall Islands, and Palau--the consequences of which we are paying for everyday. There will also be coordination and collaboration between the Department of Health and the Department of Education to ensure children and their families can access good health information and services.

Support Patient-Centered Models of Care that Focus on Prevention and Address Social Determinants of Health

Our present day acute-care model--where people seek out healthcare only when they are sick--is economically unsustainable. We need to move to a model focused on prevention and wellness. Sometimes called the "Medical Home," model is being pioneered in Community Health Centers and can be spread across the entire health system. Waianae Coast Comprehensive Health Center is a national demonstration project for the "Medical Home" model, which is already reducing healthcare costs. By focusing on prevention and a person's total health, we can avoid chronic diseases and other costly illnesses. We can also begin to address health disparities. Researchers attribute the increase in life expectancy in the U.S. during the 20th Century not so much to new medical advancements, but rather to social changes like improved wages, public education, sanitation, housing, and civil rights laws. In this century, we will make similar health improvements by growing the middle class, supporting children in the earliest years of life, ensuring access to preventive care in rural communities, and improving diets and exercise.

Develop and Implement a Comprehensive Strategy to Address Hawaii's Aging Population

Hawaii is getting older, and it is time we look at this as an asset rather than a liability. The costs of growing older are high, but if we take a preventive and empowering approach that includes our population of older adults--the vast majority of which are active and wanting to contribute--we can control costs and improve quality of life. My comprehensive plan for Older Adults and Aging lays out the steps we will take to create a Hawaii for all ages.

Lead a Multifaceted Task Force to Develop a System of Universal Healthcare

The time to develop a new vision for healthcare in Hawaii is now. Times have changed, and the Prepaid Healthcare Act that has served Hawaii so well now must be revisited. A new vision of providing healthcare to everyone in Hawaii must emerge. We have all the talent and intelligence to create that vision. As Governor, I will assemble a group including health insurance companies, healthcare providers, government agencies, community groups, business, labor, academia, concerned citizens, and others whose task will be to ensure that all people have health coverage, all have access to quality healthcare, and that costs are controlled so that we can collectively afford the system and pay for it in a way that is fair and sustainable. We need to create efficiencies out of the current incoherence in our system, create incentives and opportunities for cost-effective preventive healthcare, and ensure quality along the way. We did it before. Working together with all parties involved, I know Hawaii can do it again.

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