Health Care in Hawaii: Implications for National Reform

GAO discussed health care in Hawaii. GAO noted that: (1) Hawaii has the highest rate of health insurance coverage in the nation because of its employer mandate, Medicaid, and its state-sponsored insurance programs; (2) some Hawaiian residents do not have health insurance because the employer mandate exempts several categories of employees and the unemployed and does not require coverage for employees' dependents; (3) individuals not covered by Medicaid or the employer mandate are not required to join the state-sponsored insurance program; (4) state officials hope that their new health project will increase access to care for Medicaid participants and others by increasing reimbursements and improving service availability; (5) per capita health care costs in Hawaii are similar to health care costs nationwide, but health insurance premiums are lower in Hawaii and increase at a slower rate; (6) health insurance premiums for small and large businesses in Hawaii are similar; (7) Hawaii's low health insurance premiums are due to less cost shifting to private insurance of uninsured patients' costs, wider risk pools, and modified community ratings for small businesses; (8) although the employer mandate does not adversely impact small businesses, they dislike the cost and inflexibility of mandated insurance; and (9) an employer mandate by itself will not necessarily result in universal access to health care.