Pacific Islanders protest cuts in Hawaii health plan
The state of Hawaii is starting a new free health plan for some Pacific Island migrants but is meeting resistance from the people it aims to cover who say the benefits are much worse than what they receive today.
People from Micronesia, the Marshall Islands and Palau have since the mid-1990s received free healthcare in Hawaii through existing state health programs.
Citizens of these islands can live and work legally in the U.S. without a visa or time limits through the Compact of Free Association, or COFA, an agreement that guarantees financial assistance and migration to the island nations in exchange for military and defense rights. However, in 1996, Congress made COFA migrants ineligible for Medicaid and other federally funded services, except in emergencies.
Hawaii picked up the slack by providing the health coverage. But a budget crunch this past year caused the state to re-examine benefits to COFA migrants. In August 2009, the state notified about 7,500 of the covered migrants that they would be enrolled in a new state health plan called Basic Health Hawaii, which would offer less-generous benefits, including an elimination of chemotherapy treatments and dialysis, starting Sept. 1, 2009.
By switching the migrants to a lower-cost health plan, the state expected to save about $15 million annually and close a budget shortfall, according to the Hawaii Human Services Department. Pregnant women and children under age 19 were exempt from the change.
The COFA migrants filed a class-action lawsuit, and on Sept. 1 of last year, they were granted a temporary restraining order in federal court halting implementation of Basic Health Hawaii. In his ruling granting the stay, Judge J. Michael Seabright of the U.S. District Court in Honolulu wrote that the state failed to properly notify the COFA migrants of the switch and that it could cause irreparable harm to patients.
The state backtracked, and on Dec. 21, 2009, it issued new proposed coverage rules for Basic Health Hawaii. The revised plan offers up to 12 outpatient physician visits a year; 10 hospital days; six mental health visits; three outpatient procedures; and emergency medical and dental care. Up to four prescription drugs are covered per month, including chemotherapy drugs. Emergency dialysis will be covered through Medicaid, according to the department.
The state will save about $8 million annually with the program changes, said Lillian Koller, director of the state Human Services Department. “Because the state’s fiscal condition is worsening, DHS will likely need to cut benefits in other medical assistance programs,” Koller said in a written statement.
The new proposal may not be adequate, said Victor Geminiani, executive director of Honolulu-based Lawyers for Equal Justice, which represented the COFA migrants in the lawsuit. For instance, the state now covers patient transport to treatment, while Basic Health Hawaii would not, according to the proposed regulations. “We want to see what the final regulations look like,” he said.
The migrants may file another lawsuit against the state on grounds it is violating the equal protection clause under the 14th Amendment, Geminiani said.
In the meantime, representatives for COFA migrants are lobbying Congress to reinstate Medicaid benefits in all states. The House included such a measure in its healthcare overhaul bill; the Senate did not.
A public hearing on the revamped Basic Health Hawaii plan is slated for Jan. 25 in Honolulu. The state has set an implementation deadline of no later than July 1.