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Coverage for All Milestones

Lack of health coverage is an issue that has been pushed to the forefront by many caring and concerned community leaders.

Hawaii State Department of Health brought community leadership around the issue of Hawaii’s growing number of medically uninsured. While leadership from all sectors of the community agreed that the problem needed to be addressed, there was no single organization to adopt and champion the issue.

HMSA Foundation, the philanthropic arm of HMSA, stepped forward and made a three-year commitment to study and address the growing number of Hawaii’s people without health coverage, and The Hawai`i Uninsured Project was born.
Recognizing the importance of an open and inclusive process, a nine-month community-wide planning initiative led to a statewide “Leadership Assembly” in November 2000. Conference findings provided a starting point to initiate research and begin to draw a picture of Hawaii’s uninsured.

A year of analysis followed, along with gathering community suggestions on addressing the complex problems of the uninsured. In November 2001, the Policy Summit – Ways to Insure the Uninsured – helped to identify strategies with the greatest potential for coverage expansion.

Three areas of focus emerged:

  • employment-based insurance
  • government-based insurance
  • the safety net

Many months of intensive analysis led to further refinement of coverage options. These insights were recorded and presented to a cross-section of experts in a Coverage for All Design Forum held on May 30, 2002. This group collectively generated what is believed to be the best set of target areas for expansion.

  • the working but uninsured
  • strengthening the safety net
  • categorically eligible adults and enrollment barriers to QUEST
  • Hawaii’s children
  • Uninsured citizens of the ‘compact’ states

It was also decided that research and community discussion around the Prepaid Health Care Act was needed.

A statewide education and community-listening campaign was conducted that included presentations and informational meetings statewide.

To fund the research and the process of developing community-based solutions, federal and national grants were pursued by HMSA Foundation and community collaborators including the State Department of Health and the non-partisan, non-profit Hawaii Institute for Public Affairs so that The Hawai`i Uninsured Project could begin operating in complete independence from HMSA Foundation.

More than $2 million in grants were awarded from The Robert Wood Johnson Foundation and the U.S. Department of Health & Human Resources.

The Hawai`i Uninsured Project formed a broad-based community coalition, established in each of the target areas for expansion. Over the course of a year, these volunteer community work groups discussed the issues and proposed policy scenarios to the Social Science Research Institute to explore potential impact of coverage. The Hawaii Health Information Corporation spearheaded the effort to acquire and access the necessary private and public data sets.

The Social Science Research Institute conducted about 250 statewide interviews with the uninsured and their providers at community health centers across the state to build a better knowledge of their issues and their ideas on solutions. In addition, the team developed a socio-demographic profile of the uninsured based on existing surveys and data.

The Hawai`i Uninsured Project also set out on a fact-finding mission to learn more about current viewpoints in the marketplace today through statewide telephone surveys and focus groups: employers, part-time workers, self-employed and the general public.

On October 29, 2003, key findings from these research efforts were shared with Hawaii’s leadership for the community’s response, input and dialogue.